DA 6 FEES AND ESTIMATES Flashcards
What is production?
Fees charged
Production=dentists earn income and pay all practice expenses
Fees charged –
where a dentist earns income and pays all practice expenses
What do fees allow dentists to do?
Pay for practice expenses Income for dentisit such as Salaries dental materials lab fees rent+utilities
Account receivable
money owed to practice for service rendered
Fee Guide
“guide book “
provides suggested fees for any given procedures
How often does the BCDA fee guide change?
Fee guide changes annually on February 1st
Valid until Jan 31
dental insurance and purpose
A plan that assists patients financially
designed to make health care more accessible by reducing the cost to the patient.
WHo is involved in insurace
- Subscriber
- Dependent
- Group
- Provider
- Carrier
Subcriber
insured (employee)
Dep 00
Dependent
child or spouse of subscriber
dep 01,02
insurance Group
union or employer
identified by group/policy number
Provider
Dentist who renders appointment
Carrier
insurance company that pays claims
benifit/policies vary
e.g. PBC, Manulife
Benefits and predetermination of benefits
Benefits = covered services
predetermined: patients eligibility / preauthorized
Benifit approval
receive the predetermination of
benefits from the carrier
– outlining coverage
details
Claim
• A report of dental services to a patient’s dental
plan
Claim form includes
information about, patient subscriber, and treatment provided and fees charged.
Explanation of benefits
provided -based claim amount
received
insurance carrier’s response to a claim
What is an estimate?
• A form that outlines specific procedures and their associated estimated costs
written contract
confirming coverage
prior to procedures
prior to providing estimates
Pacific Blue Cross (PBC)
- uses its own Fee Schedule,
- based on the current BCDA Fee Guide
Ministry
MINISTRY fee guide-lowere than BCDA
not all ministry client eligible
Non-Insured Health Benefits (NIHB
First nations health program
PBC third party admin
non registered pay upfron–> reimbursement FNHA
Adminter of NHIB
(FNHA )First Nations Health
Authority
Medave Blue Cross
adminster all FEDERAL accounts immigrants armed forced veterans affair each has own fee schedule
Veteran Affair Canada
service eligible for veteran only (spouse not covered)
Through PBC
purpose of estimates
• Outlines financial options for the patient
