Express Scripts Canada Dentist in Mississauga
Book an Appointment Call 905-567-6891We direct bill Express Scripts Canada, so you pay only your share. Open 7 days, including evenings and Sundays.
We Accept Dental Plans Administered by Express Scripts Canada
Looking for an Express Scripts Canada dentist in Mississauga? At River Run Dental Centre, we accept dental plans administered by Express Scripts Canada and we direct bill Express Scripts Canada for most plans, so you usually only pay your share at the visit.
Express Scripts Canada processes pharmacy and dental claims for many private plans. It also handles dental claims for the federal Non-Insured Health Benefits (NIHB) program for eligible First Nations and Inuit patients.
We’re a family dental clinic at 11-1525 Bristol Rd W, near Creditview Rd, open 7 days a week, including weekday evenings and Sundays. New and existing patients are welcome.
Direct Billing to Express Scripts Canada
As a dentist that accepts Express Scripts Canada, we send your claim electronically at your appointment. The insurer replies within minutes with what your plan pays, and we tell you the balance before you leave.
- Bring your plan card, or your plan and ID numbers.
- If you have a second plan, such as a spouse’s, bring those details too. We can bill both.
- A few plans pay you rather than the clinic. We still submit the claim for you; you pay at the visit and your insurer reimburses you.
Express Scripts Canada and NIHB Dental Claims
Express Scripts Canada “administers claims for providers on behalf of the NIHB program” (Indigenous Services Canada). If you’re covered by NIHB, we send your dental claims to them directly, so you shouldn’t have to pay for covered services.
- Some NIHB dental services need a predetermination before treatment. We send the request and wait for the decision with you.
- If you also have a private (workplace) plan, that plan is billed first, then NIHB.
- NIHB clients can set up an account on the NIHB client website to view their claims.
If your private plan uses Express Scripts Canada to process claims, check your coverage through your insurer’s or plan administrator’s member site.
Express Scripts Canada at a Glance
The details Express Scripts Canada members ask us about most, in one place:
| What to know | |
|---|---|
| Head office | 6985 Financial Drive, Mississauga (Express Scripts Canada offices) |
| NIHB clients | 1-888-441-4777, Monday to Friday, 6:30 a.m. to 8:30 p.m. ET (Express Scripts Canada call centres) |
| NIHB predetermination status | Dental: 1-855-618-6291. Orthodontics: 1-866-227-0943 |
| Expired status card | Still works. Your registration number confirms your status |
What to Bring for an NIHB Dental Visit
Bring your status card or your registration number. Indigenous Services Canada says “Indian status does not expire”, and your registration number can be used “even if your identification card has expired” (NIHB client identification).
For a baby without a number yet, ISC says to call the Dental Predetermination Centre at 1-855-618-6291 for a temporary NIHB client number, valid until the child turns 2. See our NIHB dentist page for what the program covers.
How Often NIHB Covers Checkups and Crowns
NIHB’s dental guide sets how often services are covered (NIHB dental benefits guide). We book your visits around these limits:
| Service | NIHB limit |
|---|---|
| Recall exam | Under 17: once in any 6 months. 17 and over: once in any 12 months |
| Polishing (cleaning) | Ages 0 to 16: once in any 6 months. 17 and over: once in any 12 months |
| Crowns | Ages 18 and over, with predetermination |
| Braces | Once in a lifetime, with predetermination |
Some things are outside the program and can’t be appealed, including bridges, implants and cosmetic work. For braces, a predetermination has to reach NIHB before the 18th birthday for a refusal to be appealed, so don’t leave it late.
What Express Scripts Canada Dental Coverage Usually Includes
Your Express Scripts Canada dental coverage depends on the plan your employer or group chose, so two people with the same insurer can have very different benefits. Most plans are split into three levels:
Basic care
Exams, cleanings, X-rays, fillings, extractions and often root canals, usually covered at the highest rate.
Major care
crowns, bridges and dentures, usually covered at a lower rate.
Orthodontics
Braces and aligners, included in some plans with a separate lifetime maximum.
Most plans also have a yearly maximum and limits on how often some services are covered, such as a cleaning every six or nine months. We check these before treatment so there are no surprises.
Are Braces and Dental Implants Covered?
It depends on your plan. Some plans include orthodontic coverage for braces and Invisalign, often with a lifetime maximum and sometimes only for children. Dental implants are covered by a growing number of plans, usually as major care, while others cover a bridge or denture instead.
Before larger treatment like braces or implants, we send a predetermination to your insurer. It shows exactly what your plan will pay, so you can decide with the real numbers in front of you.
Making a Express Scripts Canada Dental Claim
You don’t need to make a dental claim yourself: we submit it electronically at your visit. Even if your plan pays you rather than the clinic, we still send the claim for you. Afterwards, you can see the claim and what your plan paid in the member website listed on your plan card.
Keep your receipts, and check that your personal and dependant details are up to date with your insurer. Most claim problems come from a changed address, a new dependant or a second plan that hasn’t been set up yet.
How Common Treatments Are Usually Covered
Every Express Scripts Canada plan is different, but most follow the same pattern. This is how common treatments are usually covered, so you know what to ask about:
| Treatment | Usual coverage | Good to know |
|---|---|---|
| Checkups and teeth cleaning | Basic care, usually the highest rate | Often limited to every 6 or 9 months |
| Fillings | Basic care | Tooth-coloured fillings on back teeth may be paid at the silver filling rate |
| Root canal | Basic or major, depending on the plan | A crown afterwards is usually major care |
| Extractions and wisdom teeth removal | Basic care | Impacted teeth may need X-rays sent with the claim |
| Gum treatment and scaling | Basic care | Often limited by time units each year |
| Crowns and bridges | Major care, often a lower rate | Some plans limit replacement to every 5 years |
| Dentures | Major care | Relines and repairs are usually covered too |
| Braces and Invisalign | Orthodontics, only if your plan includes it | Usually a separate lifetime maximum |
| Dental implants | Major care on some plans | Others pay the cost of a bridge or denture instead |
| Teeth whitening and veneers | Cosmetic, usually not covered | Bonding to repair a broken tooth may be covered |
The exact percentages, limits and waiting periods are in your Express Scripts Canada dental plan booklet. We check them for you before treatment.
Predeterminations, Claims and Annual Maximums
Predetermination
Before larger work, such as crowns, dentures, implants or braces, we send a Express Scripts Canada dental predetermination with the treatment plan and X-rays. The insurer replies with what your plan will pay, usually within a couple of weeks, so you know your cost before you commit.
Claims
We submit every claim for you, electronically wherever possible. If one has to go on paper, we complete it and send it to your insurer ourselves.
Annual maximum
Most Express Scripts Canada plans set a yearly limit on what they pay. It usually resets every January or on your plan’s anniversary date. If you’re close to your maximum, we can plan treatment across two plan years so more of it is covered.
If You Have Two Dental Plans
If you’re covered by Express Scripts Canada and another plan, such as a spouse’s, the two plans can share the cost. This is called coordination of benefits. Your own plan pays first, then the second plan can pay some or all of what’s left.
For children covered on both parents’ plans, Canadian insurers usually use the birthday rule: the plan of the parent whose birthday comes first in the calendar year pays first. We set this up for you when you bring both sets of plan details.
Finding a Express Scripts Canada Dentist Near You
Canadian dental plans, including Express Scripts Canada, generally let you choose any licensed dentist, so you don’t need to find an in-network clinic. If you’re looking for a dentist near you in Mississauga, we’re at 11-1525 Bristol Rd W, near Creditview Rd, open 7 days a week with evening and Sunday hours.
Using Your Express Scripts Canada Plan at River Run
- Book: call or book online and mention you have Express Scripts Canada coverage.
- Bring: your plan card, photo ID and any second-plan details.
- Before treatment: we check your coverage and explain any cost that isn’t covered.
- At checkout: we bill your plan directly and you pay only your share.
We also direct bill TELUS Health, Sun Life and Manulife, along with most other Canadian plans. No coverage for part of your treatment? Ask about our payment plans. You can compare all the plans and programs we accept on our dental insurance and direct billing page.
Helpful Express Scripts Canada and Dental Benefits Resources
For plan details and claims, go straight to Express Scripts Canada. These independent guides explain how dental benefits work:
- Express Scripts CanadaOfficial homepageexpress-scripts.ca ↗
- Express Scripts CanadaDental provider informationexpress-scripts.ca ↗
- Canadian Life and Health Insurance AssociationConsumer guides to health and dental insuranceclhia.ca ↗
- Canadian Life and Health Insurance AssociationGuide to understanding coordination of benefitsclhia.ca ↗
- Government of CanadaCanadian Dental Care Plancanada.ca ↗
Express Scripts Canada Dental Coverage in Mississauga: Frequently Asked Questions
Yes, for most of their plans. We send the claim electronically at your visit, and you pay only the portion your plan doesn't cover. A few plans pay you rather than the clinic; we still submit the claim for you and tell you before your visit.
Some plans include orthodontic coverage for braces or Invisalign, often with a lifetime maximum and sometimes only for children. We'll send a predetermination so you know what your plan pays before you start.
Some plans cover part of an implant as major care, while others cover a bridge or denture instead. A predetermination shows exactly what your plan will pay before treatment.
Usually only your share, such as the part your plan pays at a lower rate or anything over your yearly maximum. We explain the amount before treatment.
Most plans cover root canals as basic or major care and crowns as major care, usually at a lower rate. We'll confirm your plan's coverage and send a predetermination for crowns.
Most plans cover complete and partial dentures as major care, often with a limit on how often they're replaced. Relines and repairs are usually covered too.
Usually not. Whitening is cosmetic, so most plans don't pay for it. Your checkup and cleaning before whitening usually are covered.
You don't need to. We submit your Express Scripts Canada dental claim for you at your visit. You can then check it, and what your plan paid, in the member website listed on your plan card.
Yes. NIHB dental claims are processed by Express Scripts Canada. See our NIHB dental coverage page for what's covered and how to use it at our clinic.
Yes. Indian status doesn't expire, and your registration number can be used for NIHB coverage even if the card has expired.
No. Bridges, implants and cosmetic services are outside NIHB and can't be appealed. Crowns may be covered for adults 18 and over with a predetermination.
Call the NIHB Dental Predetermination Centre at 1-855-618-6291, or 1-866-227-0943 for orthodontics. We follow up for you too.
Call the Dental Predetermination Centre at 1-855-618-6291 for a temporary NIHB client number. It's valid until your child turns 2.
Direct Billing
Ready to Use Your Express Scripts Canada Coverage?
Book a checkup, cleaning or treatment at our Mississauga dental clinic. Call us at 905-567-6891 and have your plan details handy.
- Express Scripts Canada plans accepted for new and existing patients
- Open 7 days, including evenings and Sundays
