Smile Crew No Gap Policy/Terms and Conditions for Insurance Patients

Smile Crew No Gap Policy/Terms and Conditions for Insurance Patients

Smile Crew loves being able to help our insurance patients by making their dentistry more affordable by providing general dental services (check-up, clean, x-rays and fluoride treatment) for patients who hold dental insurance as gap-free, with no out-of-pocket cost. This means that we bill your health care provider directly using the HICAPS portal. If a full benefit is paid by your health fund, you will not have to pay any additional amount for your treatment.  *As long as your health fund pays a minimum refund of $180.00, you will have no gap to pay.  If they pay a refund of less than $180.00, you will need to pay the difference*

This service is applicable to general dental services only. It includes services such as Examinations/consultations, cleaning, X-rays and fluoride treatment. All other services will attract an out-of-pocket expense unless your health fund pays the fee for service in full.  Most “Major Dental” will incur an out of the pocket expense.

It is the responsibility of the patient (or parent/guardian) to confirm whether your health fund policy has an annual limit, what funds are available and whether you will have sufficient funds to cover the cost of your treatment.
If your health fund does not provide the full rebate amount for any service due to the yearly cap being reached, you will be responsible to pay the difference between the amount they would usually pay, and the amount they actually paid.

If your health fund does not provide any rebate on the item code for a service you will be required to pay the full amount out of pocket. We will endeavour to provide a quote for you prior to commencing any work so you are aware of the costs involved, however, it is the responsibility of the patient (or parent/guardian) to ensure they have enough benefits/funds remaining on their policy.

If a HICAPS (direct claim) cannot be made on the day for reasons such as:
A patient’s insurance being un-financial (which usually means that the policy is not up to date with payments)
The card was too damaged to be read by the terminal
The particular health fund is down on HICAPS
Any other event out of our control such as loss of power supply
You may be asked to pay for the services on the day in full, and then make a claim through your health fund. We will at all times endeavour to ensure that you do not pay any more than you are able to claim back.