Calgarypuck Forums - The Unofficial Calgary Flames Fan Community - View Single Post - Alberta's NDP government will create a dental fee guide

Northendzone · 12-13-2016, 06:24 PM

Insurance companies are generally pretty tight lipped on their claims audit procedures, or any details other than some stats on delisted practitioners etc.

Given that the insurance companies have actuaries on staff, they likely have very robust algorithms to help them find claims submission patterns.

Generally speaking, a limit of $1500 annually on basic dental services is still pretty rich as most of my clients are averting annual dental costs of around $1,300 per employee - which inludes all services for all employees some of which will be single, while others have families. So I am going to,disagree with dentomans staement.

You will likely hit limits if you incur major dental services. Even then the big part of out of pocket costs is due to the 50 or 60% coin surface that generally applies to major dental work.

Once again, it is generally not the insurance companies that controls the max, it is the sponsor of the plan - if you wanted a maximum of $5,000 you could likely get it, but the initial rates will be high due to expected utilization.

Most people generally do not max out thier dental plans unless they incur orthodontic services.

12-13-2016, 06:24 PM	#138
Northendzone Franchise Player Join Date: Aug 2009 Exp:	Insurance companies are generally pretty tight lipped on their claims audit procedures, or any details other than some stats on delisted practitioners etc. Given that the insurance companies have actuaries on staff, they likely have very robust algorithms to help them find claims submission patterns. Generally speaking, a limit of $1500 annually on basic dental services is still pretty rich as most of my clients are averting annual dental costs of around $1,300 per employee - which inludes all services for all employees some of which will be single, while others have families. So I am going to,disagree with dentomans staement. You will likely hit limits if you incur major dental services. Even then the big part of out of pocket costs is due to the 50 or 60% coin surface that generally applies to major dental work. Once again, it is generally not the insurance companies that controls the max, it is the sponsor of the plan - if you wanted a maximum of $5,000 you could likely get it, but the initial rates will be high due to expected utilization. Most people generally do not max out thier dental plans unless they incur orthodontic services. __________________ If I do not come back avenge my death Last edited by Northendzone; 12-13-2016 at 06:27 PM.