Alberta: Updated dental fee guide
Alberta released in late November 2017 a new dental fee guide effective January 1, 2018, that was developed in collaboration with the Alberta Dental Association and College (ADAC) and that recommends lower dental fees than the fee guide released in August 2017. The edition released earlier in 2017 was criticized for only including a two to three percent decrease in fees that Alberta dentists typically charged. Following the August 2017 release, the Alberta Minister of Health committed to working closely with ADAC to revise the fee guide.
The Alberta Dental Association discontinued publishing a provincial dental fee guide in 1997. Since then, insurers processing claims have created their own fee guides for Alberta to use as the basis for reimbursement. For example, Manulife’s dental reimbursement values are based on its block of Alberta claims data and are designed so that approximately 70% of submitted claims are eligible for full reimbursement. Every other Canadian provincial dental association publishes a fee guide which is updated annually.
Because of the negligible decrease in fees included in the August 2017 fee guide and the reaction of the Alberta Minister of Health, a number of insurers chose not to use it immediately. Based on responses to Morneau Shepell from a number of insurers, the new fee guide is to be adopted by the industry effective January 1, 2018.
ADAC has suggested that the new fee guide represents an 8.5% reduction in average prices for 60 common dental procedures. However, one insurer’s analysis found that applying the new fee guide resulted in cost savings of only 3.5% compared to their current reasonable and customary fees.
While the establishment of a dental fee guide in Alberta is generally favourable for plan sponsors, it is safe to say that dental costs in the province will remain above average for some time. There has not been any indication on what adjustments to the fee guide can be expected in future years.
Most group benefit contracts stipulate that reimbursements are made according to the current year’s dental fee guide, though some plan sponsors may have other contractual arrangements which will affect their costs. Some plan sponsors may need to amend their contractual wording as a result of the new dental fee guide. It is important to note that fee guides are recommendations and dental offices are not obligated to follow the suggested fees. Plan members visiting dentists who charge fees above those in the fee guide can expect to incur out of pocket expenses.