Dental Care Basis of Payment Update
If you have ever wondered how your dentist decides how much to charge you for a procedure, look no further than dental fee guides. These guides determine the appropriate charges for each dental procedure when a claim for that procedure is submitted. Of course, dentists can still charge whatever they want for their services, but the guide helps set a standard. A dental fee guide gives the most reasonable and customary rate for each dental code, allowing for more transparency overall.
Dental fee guides had normally been updated every year but were not between 1997 and 2018. The Alberta Dental Association and College (ADA&C) stopped publishing fee guides in 1997, letting dentists charge what they thought was appropriate, and costs for dental care increased significantly for almost twenty years. At one point, Albertans were paying, on average, almost forty per cent higher dental fees than British Columbians. Alberta had the highest per capita dental costs in North America at that time.
Group benefit providers needed a basis of payment for their dental coverage, and insurance companies filled in the gaps by providing their own dental fee guides based on what the marketplace was charging (called “Usual and Customary” fee guides). ARTA used a Usual and Customary fee guide for many years as the basis of payment for ARTA’s dental care plan.
Over time, the high costs of dental procedures turned into a public health issue, leading the Alberta government to work with the ADA&C to reinstate a fee guide in 2018. The hope was that this partnership would lower the dental costs of Albertans, or at least limit their growth. The 2018 ADA&C fee guide recommended fees that were, on average, 8.5 per cent lower than what was charged by the marketplace in 2016 (the last full calendar year for which they had claims experience).
This new ADA&C Fee Guide was fine-tuned over the next two years; meanwhile, ARTA continued to use the Usual and Customary fees from 2016 as our basis of payment as the new fee guide recommended fees that were 3.9 per cent higher. Overall, ARTA members had an advantage over benefit providers who had switched to the new ADA&C Fee Guide.
The ADA&C continued to adapt their fee guide, and beginning January 1, 2022, ARTA’s covered members were paying higher out-of-pocket costs for their dental treatment if their dentist used the 2022 fee guide as their basis of charges for dental procedures — the 2022 Fee Guide paid 0.9 per cent higher than the ARTA Usual and Customary Fee Guide.
To correct this discrepancy, at the February 2022 meeting, the ARTA Health Benefits Committee passed a motion recommending that the ARTA Board of Directors implement the 2022 ADA&C Dental Fee Guide as the basis of payment for ARTA’s Dental Care plan, which was accepted by the board. Beginning April 1, 2022, ARTA began using the ADA&C Fee Guide for residents of Alberta and will use the most current fee guide each year going forward.
Always review your dental charges with your dentist, including asking which fee guide they use as their basis of charges or whether they use a standard fee guide at all. As mentioned previously, the ADA&C Fee Guide provides “suggested” rates only — dentists in Alberta may still charge a rate that factors in their individual practice. Having such a discussion could allow you to maximize your coverage under ARTA’s Dental Care plan and make your benefits go further.