As a service to patients, a dental office may accept assignment of benefits whereby they agree to have the patient request that his or her dental plan provider pay the dental office directly for the percentage of the cost covered. The patient is responsible for paying the co-payment when treatment is provided. See also: What is the dental plan co-payment?
In a non-assignment office, the patient is responsible for paying the full cost of treatment at the time it is provided. The dental office will assist the patient by providing a completed dental claim form that the patient can submit to their dental plan provider for reimbursement.
In some cases, a dental plan company will only reimburse the plan holder requiring the patient to pay for all costs at the time treatment is provided. In all circumstances, the patient is responsible for any costs not covered by his or her dental plan.
Dental offices are entitled to reimbursement for services at the time treatment is provided. A dental plan is a contract between a patient and/or their dental plan carrier. As a service to patients, some offices will accept assignment of benefits whereby they agree to accept payment for the covered portion of treatment directly from the dental plan provider. Dental offices are not obligated to do so, and in some cases, are restricted from doing so as the dental plan carrier will only reimburse the patient.
The details of a patient’s plan are protected by the Personal Information Protection Act (PIPA). Due to the restrictions of a dental office in knowing what is covered by their patients' plans, they may choose to have the patient pay them directly for all services. While the dental office will help with the claim, it is the patient's responsibility to know what is covered in their plan including any limits to the plan or changes; to pay for any costs not covered by the plan; and to seek reimbursement from their dental plan provider.
The dental office may incur various expenses in preparation for the commencement of your dental treatment. It is not uncommon for dental offices to request a deposit prior to treatment.