Health Benefits
Gary Sawatzky | Chief Operating Officer , ARTA
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 ).
The ARTA Dental Care plan recently updated its fee guide to represent changes in the marketplace .
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
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