So, you’re planning to have a dental procedure?
That’s no fun. And worst of all, someone’s got to pay for it.
And what’s worse than getting a dental procedure? Having to pay for it all yourself.
Dental healthcare is not included on Canada’s single payer insurance plan, also known as Medicare.
In fact, 30% of services Canadians require are not covered by Medicare at all. This includes dental care, psychological care, optometry, and prescription drugs.
Depending on where you live, you also may not get coverage for things like prosthetic limbs or ambulance services.
But you’ve done the smart thing and gotten yourself insured by Green Shield (or are seriously thinking about it).
So does Green Shield cover your dental procedure?
Read on to find out.
Your Dental Procedure Could Be Covered By Medicare
Okay, so we said Medicare doesn’t pay for dental care. Typically, that is the case. But like every rule, there are exceptions.
If your dental procedure is so extensive that you need to be operated on in a hospital, Medicare will likely cover it. This is especially true if you have to stay overnight or the surgery is high risk.
Unfortunately, most dental procedures are performed in a dentist’s office or an oral surgeon’s office. This will often include procedures that require you to undergo anesthesia.
If your dentist or oral surgeon has not referred you to the hospital for your procedure, Medicare won’t plan on footing the bill.
Check Your Green Shield Schedule of Benefits
Green Shield has a comprehensive list of benefits depending on the policy you have taken out. Each policy insures for or reimburses for certain things, so it is important you read your insurance forms carefully.
In some cases, Green Shield will pay for your dental procedure, but not the entire thing.
For example, if you have a benefit that pays 80% of the bill, and the dentist or oral surgeon charges you $2800 for his or her services, then Green Shield will pay $2240. You will be responsible for the rest.
If you’ve gone over your limit, this may also affect if Green Shield will cover your procedure.
Most plans offer a maximum amount that they will pay for your treatment per year in each category. If you’ve hit the maximum already, you will be responsible for anything in excess, in addition to the rest of the fee Green Shield will not pay.
Taking the example above, let’s say you have a policy that pays 80% of your bill, but you’ve used up all but $1000 of your maximum reimbursement.
If the dentist or oral surgeon charges you $2800, Green Shield is responsible for $2240, which is 80%. This leaves you to pay $560. But if you only have $1000 left allotted for your medical care, they will pay the $1000 from the $2240 they are responsible for. This means you’re left to pay the $560 plus $1240. This will make your total bill due $1800, even with your insurance.
Green Shield Will Not Pay for Cosmetic Dentistry
If you are having something put in purely for cosmetic purposes, this is not covered by Green Shield. This means they will not cover implants, teeth to fill spaces or things like tooth whitening or straightening. If there is a medical need for this procedure, Green Shield may consider it.
Green Shield Does Cover Accidents
If are in an accident and knock out a few of your teeth or need dental work redone as a result of an accident, Green Shield will cover reasonable costs. The insurance company will decide what is meant by reasonable costs.
However, most plans do include an accidental dental coverage which is fairly generous. This means you can rest easy knowing if you knock out your front teeth, you won’t need to pay for most of it out of pocket. That’s unless you’ve reached your accidental dentistry maximum.
What Green Shield Will Not Cover
There are a few things Green Shield will not cover when it comes to dental surgery and procedures.
Anything related to sleep dentistry or myofascial pain syndrome is out of the running. For myofascial pain syndrome, this includes any type of diagnostics, repairs, adjustments, realignments and anything else related to the syndrome.
Green Shield does not cover services related to temporomandibular joint dysfunction, or TMJ. TMJ can be incredibly painful for those who suffer from it. The TMJ joint is defined as an issue with the joint where the skull and jaw meet.
Some people with TMJ dysfunction experience popping, clicking, severe pain and grinding their teeth as a result. One way to treat this is with a bite plate or other item to help realign or separate teeth. This is not covered by Green Shield in any capacity.
If you’re in the army, Green Shield will not cover anything that they supply to you. This will cover both material items and services.
Any illness or injury related to war, committing a criminal offence or participating in a riot or civil disobedience will also not be covered under Green Shield’s plan.
If you need dental work for wear, acid erosion, it will not be covered.
They will also refuse to cover lost, or stolen items, particularly if lost or stolen due to your own negligence.
If you purchase two items at the same time, such as a dental appliance to wear at night and alternate or a backup device, Green Shield will only pay for one.
Any dental work necessary after a car accident will also not be considered as covered by Green Field. In some cases, you can get coverage. This is if you can prove you were not at fault for the accident and the auto insurance will not pay for any services rendered by your dentist.
If you are unlucky enough to have a root canal, you will only receive one payment per tooth. This will not include anything extra that your dentist or oral surgeon must do to restore the tooth.
For those who have more than six fillings at a time, Green Shield will pay for the first one in full. The rest will be paid at a 20% discount.
If you have more than one procedure performed at a time (yikes!) Green Shield will cover only the most complex procedure. The others will be assessed accordingly.
I Am Unsure If Green Shield Will Cover My Procedure
If you’re unsure about whether Green Shield will cover your particular procedure, you can phone them directly at 1-888-711-1119. Make sure that you have your policy number available, as well as any information about the procedure your dentist or oral surgeon recommends. Your policy number should start with an OPU.
If you’d rather not talk to a human, you can go to Green Shield’s website for further questions. You can ask on the site if your procedure is covered.
What Is the Basic Dental Plan?
You may have seen that Green Shield offers basic dental coverage. This a complete exam every three years. The clock begins “ticking” after your first claim.
It also includes a full series of X-rays once every three years after you’ve made your first claim. You may get bitewings once every calendar year.
You can have your teeth cleaned and polished during each recall period. This includes topical fluoride for your teeth and to maintain basic dental health.
You may also have sealants for molars only. If you’re under the age of 14, you can only have space maintainers.
Mouth guards are available once every year.
Additionally, you will receive fillings, both temporary and permanent. You will be entitled to fillings that are tooth coloured.
You will also be entitled to tooth extraction, as well as the root that goes along with the tooth. If you need IV sedation during this procedure, Green Shield will also cover this.
If you have a comprehensive plan, Green Shield will pick up the tab for a wide variety of dental procedures.
Submitting Estimates to Green Shield
Most dental procedures are not performed the same day the dentist decides you need them done. Rather, you mostly leave and return a different day.
If you’re planning to submit your claim to Green Shield or get a pre-authorization, you should have your dentist or oral surgeon estimate the cost of the procedure. This is especially the case if you plan to spend or claim back more than $300.
Green Shield can save you quite a bit of money, depending on the work you’re having done. As healthy teeth are integral to a healthy body, you should be sure to have at least some coverage. You never know when you’ll need a dental procedure.