Everything You Need to Know About Alberta's Dental Fee Guide

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There has been a passive behavior towards dental costs for a long time in Alberta. It was common to hear, “I have coverage, so why do I care what the price is?” As a longtime consumer of Dental Benefits, I am not exempt from that statement, however being in the benefits industry has made me a savvier consumer. The fact is, Alberta dental fees are higher on average than neighboring provinces, in some cases by a substantial amount (up to 32% according to Alberta Blue Cross, and 44% according to a 2015 review).

In light of the recent release of the dental fee guide by the Alberta Dental Association and College (ADA+C), we at BCI wanted to provide an informative message to help the average consumer improve their know-how. Since the fee guide is not a regulatory document (not mandated pricing), below are the tools to help you make an informed decision.

First, some history:

Alberta has not had a fee guide since 1997, as the ADA+C stopped publishing one after that. An interesting fact from that time is, “98% of dental claim billings were at or below the suggested rates.” The ADA+C stopped publishing a fee guide because they felt it removed the competitiveness of the dental services marketplace by setting an expectation of price. Dental offices would charge based on the fee guide, not considering any of their own expenses or degree of service (perceived as economically inefficient).

In 2015, the Provincial Government and other stakeholders conducted a series of surveys and research to get a clear view of the industry. The results were released in 2016 in the “Dental Fee Review”. Here are some results in short form:

- Only 11% of those from the public survey were concerned with the value they received for their dental services

- 14% did not go to the dentist due to the cost (found it to be unaffordable)

- Stakeholders (ie. insurance companies, dental education bodies, benefit/insurance regulators, etc) “would like to see more educated dental consumers”

o   Yet conversely, they also felt a fee guide would have a detrimental effect

- Total Revenue is higher in Alberta than other provinces, however so are total costs. The percentage of profit is very similar (approx. 30%) to other provinces.

o   High costs are attribute to higher costs wages/labor, higher priced benefits, rent, and advertising

Relating these points back to Employee Benefits, higher dental rates means higher insurance premiums. There is a growing concern in Alberta that employee benefit costs are becoming too high for employers to sustainably afford. Many employers are already finding ways to ease the pain by either reducing or eliminating coverage for their employees. There is pressure in the market for prices in Alberta to be driven down, however it is left of to the consumer to do so.

What is the New Fee Guide?

This new fee guide is a list of average fees charged for the associated dental services. It is not legally mandated for Dentists to follow, simply a suggested reasonable price to charge in Alberta.

You can find the guide here. It may seem overwhelming at first glance, but it does become simpler when you know what to look for. Every procedure has a code associated with it. By comparing the code from a dental invoice/receipt to the same code in the guide, you will have a good idea if your dentists fees are fair.

This is important to note because insurance companies will only reimburse based on reasonable and customary, further mentioned below.

The Criticism

The general feel is that this is a good start, but not enough to make a substantial change. Dentists are charging too much in Alberta, as much as 32% higher than other close provinces. Many stakeholders are calling for further regulation to regulate the industry, such as requiring transparency of pricing, caps, or other restorative controls.

With the consumer ultimately being held responsible, pricing will only see slight changes. Most people chose their dentist for more than just price and will likely continue to do so. Consumer behavior is difficult to change, especially with a service so ingrained in annual routine. If there is not real pressure to change prices, then very little will happen.

What Does this Mean for ME:

1.     Ask more questions about pricing. Take the guide to your next appointment and compare what you are getting done to the guide. Talk to your Dentist.

2.     Know your coverage:

a.     What plan(s) do you have Dental Coverage with? Your or Your Spouse’s Employer Plan, NIHB (First Nations), Individual plans

b.     How much coverage do you have? Most Employee Benefit Plans cover between 80% - 100% of Basic and some cover 50% Major and 50% Orthodontics. All will reimburse based on “Reasonable and Customary charges.” This means, if an insurance company feels like a Dentist is overcharging, they may not reimburse from the full amount charged as every insurer already has their own fee guide. Even if you have 100% Dental coverage through your employer, you may still be paying out of pocket for part of a procedure. This provincial fee guide is just another piece of information for insurance companies to add to their own fee guide.

c.      Pre-Determination/Quote: For larger claims, it is important to exercise something called predetermination (or getting a quote to run by your insurance company). Insurance companies will vet larger claims and inform you how much of it will be covered, prior to any work being complete. It prevents you from getting hit with a surprise bill, and can be a sign that you are being overcharged. Comparing this to the fee guide would help as well.

3.     Research:

There is a great tool on the internet, provided by Sun Life, that everyone can use, the “Alberta Dental Fee Finder”. You don’t have to be a Sun Life client to use this feature, and it is very useful. Simply input your area code and it will output Dental Fees in your area for common procedures. It will give a minimum, maximum, average, and the Sun Life Reimbursement Fee amount.

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