My reimbursement was limited or declined. Where do I turn for clarification?
First, read the explanation from your plan administrator carefully. In most cases, it will explain how the benefit was calculated and it will identify any limitations or exclusions that have been applied. Look for language such as "Under the terms of your dental plan..", "Your plan limits coverage to.." and "These services are covered only when...". These types of statements indicate that there are limitations within your contract and they have been applied to your claim and as a result some or all of the costs associated with your treatment will remain an out-of-pocket expense not reimbursable under your plan. For more detailed information about the specific provisions of your plan, you should consult your employee handbook, discuss the matter with your benefits department or speak directly to your plan administrator. The Advisory Services Department of The Ontario Dental Association is also able to provide you with assistance and advice.