What is a Fee Guide?
The ADA&C produces an annual suggested fee guide for dentists in Alberta. This document outlines over 1,600 dental codes and code descriptors related to specific elements of dental treatment. It also provides suggested fees that serve as a guide only; dentists are not required to follow the guide or any fee schedule.
Many dental plan carriers will base plan coverage on fees and codes within this guide. In some cases the coverage is based on previous year’s guides (going back a year or more). Note: Dental plan providers do not work with the ADA&C to develop the guide.
What is dental insurance?
Dental insurance is not insurance, many Albertans have prepaid dental plans through their employers to help patients pay for some of their dental treatment. 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. It is important to understand your prepaid dental plan, prior to visiting the dentist. You can contact your employer or dental plan company to clarify the extent of their coverage.
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 per cent of the dental care received.
Dental offices can help estimate how much will be reimbursed by a prepaid dental plan by providing a pretreatment plan that can be submitted to a 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 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 per cent of the cost, but this is to the 100 per cent 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 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.
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.
Do I have dental insurance?
Many Albertans have prepaid dental plans through their employers. Many people refer to these plans as dental insurance. A prepaid dental benefit is usually part of a health benefits plan, to help patients pay for some of their dental treatment. 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.
Company A may give X amount on whatever procedures you want throughout the year.
Company B may give X amount, but with restrictions such as one dental examination every 12 months.
It is extremely important to note that you should understand your dental benefits, prior to visiting the dentist. You can contact your employer or dental plan company to clarify the extent of their coverage.
Click here for dental insurance terminology.
What if I don't have a 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.
Do dentists have to list their fees on their websites?
Dentists may advertise their services and fees on their websites. Advertising dental fees remains the choice of an individual dentist, as does the manner in which a dentist advertises their practice. For more information click here.
I don't understand dental terminology. Where can I find help?
Click here for a list of the most common dental terms.
Are dentists required to follow the provincial fee guide?
No. While many dentists will follow a number of fees within the guide, there is no requirement to do so. Dental offices consider a number of variables when determining costs for their office. A dental office may bill some, or all codes, based on the suggested fee guide. Check with your office and ask for an estimate before proceeding with treatment.
Why does my dentist charge more than the provincial fee guide?
There is no requirement for dentists to charge the suggested fees outlined in the dental fee guides. Dentists determine costs for their office based on the factors influencing their individual practice.
How are dental fees determined?
Dentists are governed by the Health Professions Act (HPA). Like hospitals, dental clinics must adhere to strict regulatory standards to ensure a high standard of patient safety and care. Dentists essentially operate mini hospitals and are responsible for a number of costs related to providing dental care.
Specialized equipment; approved materials; sterilization and safety protocols; trained and licensed professional staff; external laboratory fees and practice location factor into the overhead costs of running a dental practice. The complexity of treatment for each patient also determines treatment fees.
Dentists have to consider all of these factors in determining their treatment fees.
Is there anything I can do to limit the cost of dental care?
Regardless of the fees charged for specific procedures, regular preventative dental hygiene cleaning is still the best way to maintain good dental health in the long run.
Patients can reduce their hygiene appointment costs by practicing good dental health habits at home: brush and floss daily; limit sugary drinks and snacks; do not smoke.
It is important to diagnose problems before they become more complex and costly. Dental disease is progressive and unlike a cold will not resolve itself. The cost of prevention is always far less than the cost of neglect.
Can I get an estimate for treatment before going to the dentist?
Treatment recommendations are developed by the dentist beginning with an examination of the mouth. The dentist will examine the patient, review their health history, and discuss any symptoms or concerns the patient may be experiencing. If your dentist identifies an issue in your mouth, they will discuss this with you along with their treatment recommendations.
Depending on the treatment options presented, further discussions related to materials, the extent of the care required, whether or not laboratory fees factor into care, etc. can influence the estimate. Your dentist can work with you to review treatment alternatives and provide a cost estimate for the treatment plan before proceeding.
Note: A dentist can only provide an estimate. As with any medical-based procedure treatment planning can change over the course of treatment; this can have an influence on cost.
Can I get a second opinion; the cost estimate seems high?
It is important that you feel comfortable in proceeding with any dental treatment. Your dentist is there to support your health and answer any questions you may have, including why they are recommending the treatment presented and/or any related to cost.
If you are concerned with any factors relating to a proposed treatment plan, you are welcome to seek a second opinion. It is important to understand that there will be an additional cost associated with this as the second dentist will need to conduct an examination and consult with you to develop treatment options.
Why can't a dentist provide a second opinion without an examination?
In order to provide an opinion related to dental care, a dentist must understand all the factors that are influencing a patient’s health. A crucial part of this is an examination of the mouth to identify and diagnose any dental disease.
What questions should I be asking my dentist?
Questions you might ask:
- Why are they recommending the treatment options presented—what is/are the benefit/s to your oral/overall health?
- Are there alternative treatment options available?
- What are the implications of refusing or delaying treatment?
- Is there anything you can change in your mouth care to prevent similar issues in the future?
- What is required on my part to maintain the dental treatment recommended?