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The Patient's Responsibilities There are more than 30,000 dental plan contracts in Ontario, and each one is a little different from the next.As a smart consumer, you should make it your job to understand the details of your dental plan, and to supply your dental plan administrator with necessary information such as pre-treatment forms, claim forms or any supplementary information.As identified on the claim form you sign after you receive a service, you are responsible for the bill.
Keep in mind that this page offers a brief summary and the actual specifics of the plan will be spelled out in a contract between the employer and the dental plan administrator.
The employer enters into a dental plan contract with a third party that will act as the plan administrator.
For example, a toothache can result in oral infection if not treated on time.
This can pose a great risk to patients who are in poor overall health, particularly those who suffer from heart disease.
The helps dentists derive fees, but this is only a guide and the fees are only “suggested.” A dentist may use this guide to formulate a fee for their dental services.
Once a dentist has established a fee for a certain service, with special exceptions, he/she will charge that fee to all patients, regardless of whether or not the patient has a dental plan.
Your dentist will supply any information you request, but it is your responsibility to provide it to your dental plan administrator.
This ensures that your health record remains confidential and your privacy is protected.
For some dental services, payment may be based on a cost-sharing arrangement between the employer and employee.
In these cases, the patient pays for a portion of the cost, while the plan pays for the remainder.