Dental insurance, and how it works here

Swipe instead of paying upfront

Guardian Life issues an easiClaim card to members on a PROVISOR plan. You swipe it at our reception desk, much as you would a bank card — before you go through, not afterwards — and three things happen:

1. Your benefits are checked in real time against your plan.
2. You are shown an estimate of your own out-of-pocket cost — the part the plan will not cover — before the work is done.
3. The claim is submitted for you. You do not pay the full amount and wait to be reimbursed.

Guardian's own description is that the card gives members "real-time access to their benefits" at "Dental and Vision Preferred Providers" in the network, with a "real-time estimation of their out-of-pocket expense before services are rendered".

Smile Works DentaSpa is listed in Guardian's provider directory, so you can confirm us there before you come.

Dental is one of only two categories where the card works at present — the other is vision. Guardian says it is being extended to the rest of the network. That is worth knowing: a dental practice in the network is one of the few places the card does anything today.

Not sure whether your Guardian plan carries the card? You can check Guardian's own preferred provider directory, or call them on (868) 226-6944. Or simply bring the card in and we will tell you in a minute.

Who we are a preferred provider with

We have held preferred provider status for over 15 years with Guardian Life, Sagicor, Pan-American Life, Cardea and others.

What "preferred provider" actually means, since the phrase gets used loosely: the practice holds an agreement directly with the insurer. In practice that usually means the paperwork travels from us to them rather than from you to them, that the fees are ones the insurer has already agreed, and that there is a working relationship when a claim needs chasing.

It does not mean everything is free, and it does not change what your particular plan covers. Anyone implying otherwise is selling you something.

We also offer a TTARP discount on various procedures.

What we do before treatment starts

This matters more than which logos we list.

• We check your entitlement first. Before treatment, not after — so the number you hear is the number you pay.
• You get an itemised quotation. What the treatment is, what it costs, and what your plan is expected to cover.
• Where a plan requires pre-authorisation, we tell you and we submit it. Larger work — crowns, implants, gum surgery — often needs the insurer's agreement in advance, and starting without it is how people end up paying for treatment they believed was covered.
• If the cover falls short, you hear it from us before you commit, not from a statement afterwards.

We publish our prices as well, so you can work out any shortfall yourself: what treatment costs.

What dental plans usually do and do not cover

Plans differ, and yours is the authority. But the shape is fairly consistent across the local market, and knowing it prevents most of the unpleasant surprises.

Usually covered, at the highest rate: examinations, x-rays and cleanings. These are the treatments insurers most want you to have, because they are what stops the expensive work.

Usually covered, at a lower rate: fillings, extractions and root canal treatment — often described on a schedule as "basic" and "major" restorative, at different percentages.

Often limited, or subject to a waiting period: crowns, bridges, dentures, implants and orthodontics. Waiting periods on major work are common, particularly in the first year of a new plan.

Usually not covered at all: anything the plan classes as cosmetic — whitening, veneers, facial aesthetics.

Two limits catch people out more than any exclusion does: the annual maximum, a ceiling on what the plan pays in a year that large treatment reaches quickly, and the gap between "covered" and "covered in full".

If you have no dental cover

Plenty of people do not, and it is not a reason to stay away until something hurts.

We publish our prices, which very few practices here do, so you can plan rather than guess. An examination with x-rays costs far less than what it usually finds, and a second opinion on another dentist's treatment plan is free, with no conditions.

Going to the dentist without insurance in Trinidad covers what to prioritise when you are paying for it yourself.