For a clear understanding of your coverage and to eliminate any surprises, it's essential to contact Support prior to your appointment. Use the number on your insurance card or check your Dashboard to inquire about the amount they will cover.
Sometimes, especially with dental and drug insurance coverage, what is and isn’t covered can be a bit of a surprise. You might ask yourself, “Why didn’t my insurance cover this?” or, “Is my coverage covering the correct amount?”
Generally speaking, we recommend reviewing the specifics of your insurance policy before paying for the treatment to avoid any surprise out-of-pocket expenses.
However, with regards to drug coverage, policies typically cover either the name brand drug or the generic drug, depending on what applicable guidance deems cost- and treatment-effective. That means that in some cases, your coverage might consider generic antidepressants sufficient for most patients’ needs and only cover the non-name brand drug to reduce costs. Alternatively, WEBC might deem only a brand-name painkiller acceptable for coverage due to its everyday use in clinics and hospitals.
If you’re unsure if your healthcare provider will cover a specific prescription, contact us with the prescription’s DIN (Drug Identification Number). We can verify how much of the cost your policy will cover.
Regarding dental coverage, each treatment in a dental clinic has a corresponding treatment code and a conventional number of units, with one unit usually meaning fifteen minutes of treatment. Insurance policies use these codes and units to define coverage. If you know what treatment you expect, you can generally check your policy to see how many units it covers and the frequency of each treatment.
Some treatments, such as X-rays, are usually covered once every 12 months, whereas things like check-ups and cleanings are covered once every 6-9 months, depending on your insurer and the level of coverage you signed up for.
Unlike DINs for drugs, treatment codes for dental coverage are subject to change and vary by province. If you’re unsure whether your insurance will cover a treatment, it’s best to contact us in advance to discuss your coverage. If you’ve already paid out-of-pocket and are uncertain about reimbursement, provide them with the treatment codes on your bill; they can inform you of your plan’s specific coverage and whether they can reimburse you.
We recommend finding the codes associated with your prescriptions and treatments because insurance policies don’t always offer 100% coverage, even if you’re confident about coverage. Depending on your policy, there might be out-of-pocket deductibles (a fixed amount you pay before your insurance kicks in) or co-payment fees (a percentage of the total cost you pay). You can only confirm this information with your enrolment letter or by contacting Support because it’s specific to your policy and treatment plan.
Therefore, the most effective way to find out how much your insurance should cover is to learn as much as possible about your treatment and then contact Support. You can do this by calling the number on your insurance card or visiting your Dashboard. Ask what amount of coverage you can expect at the counter.