DA 6 FEES AND ESTIMATES

Question 1

What is production?

Answer 1

Fees charged

Production=dentists earn income and pay all practice expenses

Question 2

Fees charged –

Answer 2

where a dentist earns income and pays all practice expenses

Question 3

What do fees allow dentists to do?

Answer 3

Pay for practice expenses
Income for dentisit
 such as Salaries
dental materials
lab fees 
rent+utilities

Question 4

Account receivable

Answer 4

money owed to practice for service rendered

Question 5

Fee Guide

Answer 5

“guide book “

provides suggested fees for any given procedures

Question 6

How often does the BCDA fee guide change?

Answer 6

Fee guide changes annually on February 1st

Valid until Jan 31

Question 7

dental insurance and purpose

Answer 7

A plan that assists patients financially

designed to make health care more accessible by reducing the cost to the patient.

Question 8

WHo is involved in insurace

Answer 8

1. Subscriber
2. Dependent
3. Group
4. Provider
5. Carrier

Question 9

Subcriber

Answer 9

insured (employee)

Dep 00

Question 10

Dependent

Answer 10

child or spouse of subscriber

dep 01,02

Question 11

insurance Group

Answer 11

union or employer

identified by group/policy number

Question 12

Provider

Answer 12

Dentist who renders appointment

Question 13

Carrier

Answer 13

insurance company that pays claims
benifit/policies vary
e.g. PBC, Manulife

Question 14

Benefits and predetermination of benefits

Answer 14

Benefits = covered services

predetermined: patients eligibility / preauthorized

Question 15

Benifit approval

Answer 15

receive the predetermination of
benefits from the carrier
– outlining coverage
details

Question 16

Claim

Answer 16

• A report of dental services to a patient’s dental

plan

Question 17

Claim form includes

Answer 17

information about, patient subscriber, and treatment provided and fees charged.

Question 18

Explanation of benefits

Answer 18

provided -based claim amount
received
insurance carrier’s response to a claim

Question 19

What is an estimate?

Answer 19

• A form that outlines specific procedures and their associated estimated costs
written contract

Question 20

confirming coverage

Answer 20

prior to procedures

prior to providing estimates

Question 21

Pacific Blue Cross (PBC)

Answer 21

• uses its own Fee Schedule,

- based on the current BCDA Fee Guide

Question 22

Ministry

Answer 22

MINISTRY fee guide-lowere than BCDA

not all ministry client eligible

Question 23

Non-Insured Health Benefits (NIHB

Answer 23

First nations health program
PBC third party admin
non registered pay upfron–> reimbursement FNHA

Question 24

Adminter of NHIB

Answer 24

(FNHA )First Nations Health

Authority

Question 25

Medave Blue Cross

Answer 25

adminster all FEDERAL accounts 
immigrants
armed forced
veterans affair 
each has own fee schedule

Question 26

Veteran Affair Canada

Answer 26

service eligible for veteran only (spouse not covered)

Through PBC

Question 27

purpose of estimates

Answer 27

• Outlines financial options for the patient