Assignment Of Benefits

Assignment of benefits is better known by many patients as ” my insurance company pays you directly”.

“Assignment of Benefits” is a legally binding agreement between you and your Insurance Company, asking them to send your reimbursement checks directly to your doctor.   Some things to note about assignment of benefits and insurance coverage in general:

Your insurance benefits are meant to offset, not entirely cover the cost of care. A few plans do cover quite a bit, and that is great, but with over 65,000 plans in Ontario alone, most patients do pay a portion to their dentist or doctor as well.  Patients may pay:

“Deductible” refers to the first portion of care costs incurred during the year.   For example, if you have a $50 deductible, that means that your Insurance Company expects you to pay for the first $50 of the care you receive in the given contract year.   After that, your regular benefits will apply for the reminder of the calendar year.

“Co-insurance”  or “patient portion” refers to that percentage of cost which the Insurance Company expects you to pay.   If your “co-insurance” is 80%, this means that the Insurance Company will pay 80% of what they consider “usual and customary”, and that they expect you to pay all the rest of the costs for services you have.

“Co-pay” refers to a specific charge you may have to pay for a particular service.  Not all policys include co-pays.

Any deductible, co insurance or patient portion or co-payment is always payable on the day you receive care.  Just like buying groceries, or a new pair of sneakers, services are paid for on the day you have them.

Some plans are non-assignment, which means that they will only pay you, the patient, directly.  If your plan is non-assignment, you pay your dentist in full, on the day of service.  Your plan pays you within 2-3 business days, usually by direct deposit into your bank account.

Questions about your insurance? Call us for quick and easy answers! 905-697-9799 or send us an email.