Understanding Dental Fees
As health care professionals, dentists are focused on providing you with individual care to support your dental and overall health. Understanding how those costs are established and how you can find out about the cost of your care before treatment will help you make the best decisions for your health.
Dental fees are based on the costs of doing business. For dentists, these costs include capital costs, rent, dental instruments, staff salaries, equipment, computers and other materials. While the cost of operating a dental practice in Alberta can be higher than other provinces, a comparison of dental fees for common procedures across the provinces shows that some procedures are more expensive while some are less.
Dental benefits provided by dental plan companies have not kept pace. Even if the description of benefit coverage indicates 100% coverage of dental fees, insurers often set a maximum reimbursement that is lower than the actual fee. Any difference is paid for by the patient.
Dental services are highly individualized and the cost may vary from person to person. For example, cleaning the teeth of a person who eats healthy foods, brushes and flosses after every meal or snack will not take as long as cleaning the teeth of a person who smokes and is not as diligent in brushing. Someone needing a crown may also require periodontal (gum), endodontic (root canal) and/or restorative (filling) treatment before proceeding with the crown.
If you do not understand or are unclear about anything with regard to your proposed treatment or costs, ask your dentist
Dentists can advertise their services and fees in an ethical manner.
In Alberta, all professions, including dentists, have rules about what its members can say in advertising. Those rules are in place to both protect the public and to protect the reputation of a profession. The rules state that a dentist cannot be deceptive or misleading in their advertising, creating a situation that could potentially harm a patient or leave the patient confused about the treatment or qualifications of the treating dentist.
Advertising dental fees remains the choice of an individual dentist, as does the manner in which a dentist advertises their practice.
What is "Dental Insurance"?
“Dental insurance” is not insurance as it is really a prepaid dental benefit plan and are a means to help patients pay for some of their dental treatment. Many Albertans have prepaid dental plans through their employers. Many people refer to these plans as “dental insurance” but they are actually a prepaid dental plan. This means that an employer will determine how much money will be available for dental procedures. Some may, or may not, have restrictions or limitations. What is meant by that is Company A may say spend the prepaid amount on whatever procedures you want throughout the year, Company B may say, of this money, you are only entitled to one dental examination throughout the year. It is extremely important to note that you should understand your prepaid dental plan (dental insurance), prior to visiting the dentist. You can contact your employer or dental plan company to clarify the extent of their coverage.
Most Albertans (73%) have access to prepaid dental plans through their employer and the dental plan (dental insurance) companies that provide them are actually benefit administrators. Dental plan companies reimburse you based on the level of coverage decided by your employer. Prepaid dental plans are developed to assist patients with paying for dental care, not to pay for 100% of the dental care received.
Dental offices can help estimate how much will be reimbursed by a prepaid dental plan by providing a pre-treatment plan that can be submitted to a prepaid dental plan administrator for an estimate of what will be reimbursed for a particular service. This is referred to as a predetermination of benefits. Dental plan (dental insurance) companies have their own fee schedules of what they will contribute towards the dentist’s professional fee. A particular prepaid dental plan may say they pay 100% of the cost but this is to the 100% value set by the prepaid dental plan which may not match the professional fee of the dentist.
Dental plan coverage was developed by the insurance industry with little to no input from the dental profession and can be confusing to both patients and dentists. Dental plan (dental insurance) premiums have gone up year over year but for the most part, dental plan benefit maximums have remained the same. In effect this means that in today’s dollars the maximums have actually decreased due to inflation.
Understand Your Dental Benefits
Many Albertans have a dental benefit plan, frequently referred to as dental insurance, through their employers. These are prepaid dental benefit plans and a way to help pay for some of your dental care.
Dental benefit plan companies reimburse patients for dental procedures and care based on a level of coverage determined by the employer. In most cases, dental benefit plans do not cover 100% of a procedure or your dental care needs. That may be because the plan requires a co-payment, has a maximum dollar limit, procedure frequency limitations, or because the benefit provider limits the total amount they will pay for a particular procedure, regardless of the actual fee for the service. You are responsible for paying the portion not paid by the dental benefit plan.
It is important that you understand your dental benefit plan. Read the information provided to you on your plan. Understanding your coverage level is helpful in preparing for your dental care.
Things you should know include:
- what procedures and services are covered and are there frequency limitations (for example, your benefit plan may cover cleaning once or twice a year) - whether or not you have deductibles (that amount you have to pay before your benefit plan covers any portion of a claim - what the required co-payment is - whether or not there is a total dollar limit on your coverage - what happens to your coverage if you change jobs
Your dentist can help you understand what your plan covers, and can submit a predetermination form to your plan so you will know what your plan covers before any treatment has begun. If you do not understand or are unclear about anything with regard to your proposed treatment or costs, ask your dentist.
It is important to remember that your dental benefit plan is not a treatment plan and should not dictate your treatment. Along with your dentist, you should determine your dental care needs. Whatever your dental health care needs, ask your dentist about treatment options and costs so that you can make a fully informed decision before proceeding.
Other helpful information to know includes
- what if I have dual insurance coverage e.g. you and your spouse both have a benefit plan - what payment options are available
No Dental Benefit Plan?
Whether you have a plan or not, discussing your treatment options and costs with your dentist helps you make an informed decision. Your dentist wants you to fully understand your treatment options and the associated costs. If you don’t understand or are unclear about anything with regard to your proposed treatment or costs, ask your dentist.
Help for Low Income Albertans
Alberta dentists provide dental services at reduced fees for Albertans through various social programs offered by the Government of Alberta. Whether or not you are experiencing hardship discuss payment options with your dentist. As health professionals, dentists are committed to caring for your health.