High and rising dental costs prompt Alberta insurer to refuse increase in 2016

Faced with skyrocketing claim costs, one of Alberta’s largest public sector benefit providers says it will hold the line next year on the fees its will cover for charges by the province’s dentists.

The Alberta School Employee Benefit Plan — which provides coverage to more than 55,000 public and separate board employees — said in a recent report that it saw payouts for dental care increase by 11 per cent last year to $59 million.

The November document notes the average annual increase in fees charged by dentists in Alberta was 3.8 per cent over the last five years, a rise that was 1.5 times larger than the province’s consumer price index.

“Fees in Alberta are the highest in Canada and are generally considered (some) of the highest in North America,” the report says.

Trustees with ASEBP have decided to strike an advisory panel on dental plan design and fees to look at focusing coverage on “prevention and services which have a high therapeutic value.”

In anticipation of getting recommendations for changes to the plan, the union and school board overseers have decided not to increase the maximums they will pay for procedures next year beyond the fees listed on its 2015 dental benefit list.

If and when a dentist levies a fee in excess of those on the list, plan members will need to pay from their own pocket to cover the difference.

Despite the province’s faltering economy, the Alberta Dental Association and College says a survey of its members this year found an average overall fee increase of 3.2 per cent.

While a 2013 internal study for AD&C found the province’s dentists have historically charged more than their counterparts elsewhere in Canada, the organization issued a prepared statement this week that contradicted that finding.

“Our own review of fees across the country show Alberta’s fees are on par with other provinces,” the statement said.

“This is in spite of the fact that the cost of doing business in Alberta is unique…salaries for dental hygienists and dental assistants are higher.”

The AD&C is unique in Canada in that it has a dual role to both regulate dentists and promote the $1.5 billion industry.

Alberta is also the only province without a suggested fee guide, which is commonly used by insurers and plan providers as a basis for claims reimbursement.

The AD&C stopped publishing a guide in 1997 amid criticism the listing was actually working as a schedule of floor prices that discouraged competition and a battle with the province’s largest benefits provider, Alberta Blue Cross, over its efforts to control the growth in dental costs by negotiating lower charges with designated dentists.

The move now by ASEBP comes as Health Minister Sarah Hoffman continues her department’s investigation into the high cost of dental care in the province.

Announced last July in the wake of Herald stories about the high and rising cost of dental care in Alberta and massive discrepancies in pricing for the identical procedure among dentists in the province, Hoffman told the legislature this week that the review is expected to be completed sometime in 2016.

“I’m not going to give a month quite yet because I want to make sure we get the review right,” she said.

Liberal leader Dr. David Swann demanded Hoffman limit what he called AD&C’s “extreme limitations on dentists’ public information and advertising,” including disallowing special offers for low-income patients and seniors.

Hoffman said the government was looking at the possibility of lessening the restrictions on advertising by dentists.

“Certainly, this is one of the things we will be considering,” she said.

The AD&C’s most recent annual report shows that at the start of this year over 20 per cent of the 145 complaints it had open were related to advertising.

“Dentists are permitted to advertise and promote dental fees if they choose to do so,” the organization said in its prepared response.

“When advertising fees, the advertisement must only be intended as information for the public and must comply with the…code of ethics.”

That code requires promotions by dentists contain “objectively verifiable statements” and that they don’t “tend to harm the dignity and honour of the profession.”

Hoffman said in a prepared statement that her staff are working with a variety of stakeholders, including the AD&C, to compile an overview of fees and fee schedules and review public and private dental plans.

“We are also looking at some of the factors that may be driving costs in Alberta and comparing that to what is happening in other provinces,” she said.

Alberta Blue Cross, which paid out over $430 million in claims to the province’s dentists last year, has said it welcomes the government’s review into what it says are the “high cost” of services.

“(We) have a keen interest in dental costs as they directly affect the viability of customers’ benefit plans and the affordability of regular dental care and treatment,” the company said in a prepared statement.

Alberta Blue Cross said it will increase the usual and customary fees it uses as a basis for payment of dental claims in the new year based on data on actual billings it has received over the last 12 months, but it declined to say by how much.

The federal competition bureau is also working on a long-awaited look at the dental profession, includes an examination of restrictions on advertising.

A draft copy was shared with dental regulators across the country last fall, but the watchdog agency has yet to make its final report public
.

Source: http://calgaryherald.com/news/politics/high-and-rising-dental-costs-prompt-alberta-insurer-to-refuse-increase-in-2016

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