Unpaid Claims and Extra Billing

 

I think all of us at some point in our lives have felt cheated or frustrated with our employee benefits provider due to either the lack of or partial payment of a claim.  It has been our experience when we get involved in these situations there is one of three reasons why a claim was not paid in its entirety:

1.         The claim was adjudicated correctly according to the contract

 2.         The insurance company made a mistake

 3.         Extra billing (dental or pharmacy markup)

It is really point "3" that is motivating this discussion.  As was the case several years ago with generic drugs, the Alberta Government has recognized there is an unfair practice occurring with the health care system and in this case is trying to indirectly influence this situation.

 Extra billing occurs when a dentist (or pharmacy) charges above the reasonable and customary cost for a service or prescription.  As most of you are aware, there has been no dental fee guide in Alberta for many years which has led to an increased practice of extra billing.  The government of Alberta conducted a review of dental fees and found costs in Alberta are rising faster than in other jurisdictions across Canada, all of which have a fee guide.  To address this concern the Alberta government and the Alberta Dental Association and College are developing a fee guide so Albertans can better compare prices and make well-informed decisions about their dental care. 

 Stay tuned for more information about the guide and when it will be posted.