At Grande View Dental Care, we are committed to making dental care accessible, transparent, and easy to understand. We offer direct billing to most insurance providers and provide guidance to help you navigate your dental benefits with confidence.

Direct Billing

We electronically submit claims to your insurance provider on your behalf whenever possible.

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Our Direct Billing Services Include:

• Electronic claim submission

• Coordination of benefits (if you have more than one plan)

• Assistance reviewing insurance responses

• Predetermination (per-approvals) upon request

If you have two insurance plans, claims are submitted to the primary insurer first. Any eligible remaining balance is then forwarded to the secondary insurer according to standard insurance guidelines.

Any amount not covered by insurance (the patient portion) is your responsibility and is due at the time of service.For plans that do not allow direct billing (often out-of-province policies), full payment is required at your appointment. A detailed receipt will be provided for reimbursement submission.

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Primary & Secondary Insurance (Coordination of Benefits)

If you are covered under two plans:

• For adults, the primary plan is typically the plan where you are the policyholder (for example, your employer-sponsored plan).

• The secondary plan is usually coverage through a spouse or partner.

• For dependent children, most insurers follow the “birthday rule.” The parent whose birthday (month and day, not year) occurs earlier in the calendar year holds the primary plan.

Claims must always be processed by the primary insurer before submission to the secondary insurer.

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Patient Responsibilities

To ensure accurate claim processing:

• Provide current insurance information at every visit

• Inform us immediately of any changes to your coverage

• Understand your coverage percentages, frequency limits, and yearly maximum

Due to privacy legislation, certain policy-specific questions must be addressed directly between you and your insurance provider.

Your dental account remains your responsibility regardless of insurance coverage.

 

How Dental Insurance Works

Dental insurance plans vary significantly between providers and individual policies. Coverage amounts, annual maximums, frequency limits, and exclusions differ from plan to plan.

Treatment recommendations are based on your clinical needs — not on what your insurance covers. Insurance is a financial benefit and should not determine your oral health decisions.

 

Key Insurance Terms

Coverage Percentage
The portion of treatment costs your insurer reimburses (e.g., 80%).

Annual Maximum
The total dollar amount your insurance company will pay within your benefit year.

Frequency Limitations
Restrictions on how often certain services are covered (e.g., exams, cleanings, fluoride treatments).

Exclusions
Procedures not included in your plan. Cosmetic treatments are commonly excluded.

Fee Guide
Insurance reimbursement is based on your provider’s fee guide, which may differ from our office fees.

Predetermination of Benefits
A submission sent to your insurance provider before treatment begins to estimate reimbursement. Responses typically take 2–6 weeks and may be sent directly to the patient.

Contact Grande View Dental Care

For questions about your insurance coverage or assistance understanding your benefits, please contact our office:

📞 780-827-3602

Grande View Dental Care
Professional care focused on long-term oral health.