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Wednesday, September 12, 2012

Why do I have to pay the Co-pay? (Why do I have to pay what my insurance doesn't?)

This question we get asked from time to time here in Southern Ontario.
For those who don't understand the term.  The Co-pay is that portion of the cost of treatment that the insurance provider does not pay and is the responsibilty of the patient.  For example, if the insurance provider pays 80% of the cost, the patient must pay the other 20%.  Or if the inusrance pays 100% on an older fee guide then the patient must pay the difference.  This is called the Co-pay.  Some patients ask the Dentist if the Dentist would accept whatever the insurance company pays as full payment.  In our jurisdiction, the Province of Ontario, this is not allowed.  A dentist caught doing this, in our province, would face consequences visa vie his dental liscense and from the insurance companies.  The reasoning behind not allowing this discounting of the fee to the patient is that if the provider discounts  his fees to the patient then he should also be giving that same discount to the insurance company.  Although everyone thinks what is the big deal the insurance company is paying, well the insurance company is no different from anyone else.  The way you look out for your money so do they.  If you get a discount then they want one too.  I don't know what the laws are in other jurisdictions but I would imagine that they are similar.
We are always trying to help out our patients but as professionals our word truly is our bond and any Dentist who does not collect this fee is in violation of the terms of his certificate and will suffer the consequences if caught.  Any dentist who plays fast and loose with the rules, at the end of the day is not the type of person you want performing your dentistry either.

All the Best

Dr. Ron Barzilay

Having fun in Hamilton Ontario

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