Direct Dental Insurance Billing | Hamilton | Spinel Dental

DENTAL INSURANCE DIRECT BILLING

Here at Spinel Dental, we want your dental visits to be comfortable and stress-free. We recognize that insurance forms and policies can be complicated so it is our goal to assist our patients with understanding and utilizing their insurance company to help simplify this part of your dental visit.

Our office accepts most insurance plans. We will gladly direct bill your insurance company. We process insurance claims and accept payment directly from insurance companies. Please ask one of our team members for more information regarding our direct billing policy and procedures. We will gladly assist you with electronic submission of your dental claims if required. This has the benefit that you will only pay what is not covered by your insurance plan at each appointment.

Affordable Dental Treatments

At Spinel Dental we are committed to providing our patients with personalized, high-quality treatments at affordable prices. We follow the Ontario Fee Guide for all of our dental services.

We do our very best to ensure smooth and easy payment transactions for all of our patients. Our computerized insurance system allows us to store insurance information and submit claims electronically or by forms. Our office is able to direct bill ALL insurance plans ( Which accept Direct Billing ). For more information on insurance billing or if you have any questions/concerns, please feel free to give us a call anytime at:

905 318 6106

or email us at

smile@spinel.dental

What is Direct Billing for Dental Insurance?

Direct billing is a convenient method for handling insurance payments to your dentist. We are pleased to provide direct billing at Spinel Dental. If you have dental insurance and plan to visit us, we’ll be happy to help you find out if it’s supported by your insurance provider and what’s needed for you to take advantage of this option.

How Direct Billing for Dental Insurance Works?

Direct billing is as easy as it sounds. Spinel Dental uses direct billing, and we will submit the bill for your services directly to your insurer rather than bill you. We then handle all the paperwork that’s needed to receive reimbursement from your insurance company. Direct billing is greatly preferred by patients because it means they have little to no contact with the insurance company while we handle all the legwork.If you have insurance coverage, we will enter it into our computerized system. At the end of the appointment, we will send your electronic bill directly to your insurance company for payment rather than giving you the dental cost breakdown and the hassle that comes with filing the claim yourself. Typically, the insurance company will pay us the appropriate dental procedure costs and we will collect the difference (those costs that aren’t covered by your insurance agreement) from you.


Our office prides itself on providing a very high standard of dental care at a fair price. We are transparent with our billing as we don’t want to spring any surprises on our patients. After your first visit, you can expect to receive a clear, detailed estimate of your dental costs which includes a price quote for recommended procedures, so you can make a clear and informed decision on how to proceed with your treatment.


At your appointment we will submit a claim to your Insurance Company and only charge you for the portion which is not covered by Insurance. We accept all insurance plans; private, employee, as well as government coverage such as Provincial Health Benefits.

What Patients Need to Provide for Direct Billing Dental Insurance?

You’ll need to give our office staff your insurance information and photo ID. You should also contact us prior to your appointment to make sure there are no surprises and that direct billing is available for your insurance plan. Not all dental insurance companies accept direct billing assignment, which we’ll be able to tell you when you speak with us. Making a quick phone call could save you some potential last-minute hassles or unpleasant surprises at the end of your visit.

What Happens After a Direct Bill is Submitted?

If you made your portion of the payment at the time of service, you shouldn’t have to deal with your dental bill again when you’re using direct billing. You may receive a statement from your insurance company detailing what it paid, but you won’t see another bill.


If you didn’t pay your portion of the bill at the time of service, then you should expect a bill from us. This will come with an explanation of what your insurance company has paid for and what you are responsible for paying. You may receive a similar statement from the insurance company.

If your insurance company doesn’t offer direct billing, you will be asked to pay for the entire cost of your services at the time of your appointment. Again, it is important to get an accurate estimate for the work to be done just to make sure you’re prepared for this expense. Major restorative care can easily cost hundreds of dollars, which could be difficult to cover if you’re paying the entire bill upfront.


After paying the bill, you then will submit it to your insurance company. The insurance provider should then reimburse you for the portion that it’s responsible for. In the case of standard preventive care, you may be reimbursed for the total cost. You can ask us to check with your insurance provider before making your appointment to find out what services it will and won’t cover.

Common Insurance Terms

Maximum: Many insurance plans have a dollar maximum. The coverage period is either the policy year or the calendar year. The plan may specify a separate maximum for basic treatment and for major treatment (crown and bridge, dentures.) Often the maximum is combined.

Coverage Year: Coverage may be based on a policy year or on a calendar year.

Deductible: Some insurance plans have a deductible, which is a dollar amount which the insured must pay before the Insurance Company pays the claim. A deductible may be per individual or per family.

Co-Insurance: The patient co-insurance is the percentage of the Insurance Company fee guide which is payable by the patient. If the coverage is at 100%, the patient is responsible for the difference in the fee guides, if any. If the coverage is at 80%, the patient pays the 20% as well as any fee guide difference.

Frequency Limitations:  Your plan may limit the frequency of exams, tooth polishing, fluoride and x-rays.

Dental Cleaning Limitations:  If you are advised to have dental cleanings in excess of the exam and polishing limitations, you are likely still covered for the very important scaling or root planing component of these appointments.

Scaling, the removal of subgingival plaque, is measured in 15-minute intervals. Typically Insurance plans provide for 8 to 12 units per calendar or policy year and may be on a revolving basis. Generally, a cleaning appointment is 3 to 4 units of scaling (45 to 60 minutes), such that 12 units would allow for either 3 or 4 cleaning appointments per coverage year. Exams and polishes are thus scheduled in compliance with the Insurance terms, and not done at each cleaning appointment.

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