It’s no surprise to most Albertans that dental fees in the province are the highest in Canada by a wide margin. Recent statistics from Alberta Blue Cross show that, on average, the cost of dental services are about 30 per cent higher in Alberta than in the neighbouring provinces of British Columbia and Saskatchewan. A typical recall appointment can be double the cost.

Part of the reason for the difference is the Alberta Dental Association hasn’t published an annual fee guide since 1997. Every other provincial dental association in Canada publishes an annual fee guide to help dentists set competitive pricing. But it’s the Wild West in Alberta when it comes to dental prices, as they can vary significantly from one dentist to another.

In Alberta, 100 per cent coinsurance doesn’t necessarily guarantee an employer group insurance plan will fully reimburse a dental visit. Dentists’ fees often exceed insurers’ reasonable and customary guidelines for reimbursement, meaning employees may leave the dental office with unexpected out-of-pocket expenses. Rather than questioning their dentists, employees are more likely to complain to their employer’s human resources or benefits department.

Read: Alberta dental costs ‘truly unsustainable’

In search of answers to explain why dental fees in Alberta are so high, I went straight to the horse’s mouth: my dentist. Dr. Mustafa Esmail has been looking after my family’s teeth for more than 10 years. He runs a successful practice on the fringe of Calgary’s city limits, far from the gleaming high-rent oil and gas office towers downtown. Esmail was just finishing dental school when the Alberta association last published an annual fee guide, so he has always had the freedom to set his fees. Personally, I’ve found his fees to be largely in line with insurers’ reasonable and customary reimbursement guidelines.

Esmail’s explanation for the disparity in fees between Alberta and the rest of Canada boils down to much higher wages here for dental staff, including hygienists and dental assistants. Attracting talent has always been a challenge, he says, noting there have been times when he has advertised for a hygienist and received less than a handful of applications. In the energy industry’s boom years, competition was fierce. Local dental practices would often lose staff to competing practices in Calgary’s city core that were offering wages as much as $5 per hour higher. Despite the recent economic downturn in Alberta, Esmail says attracting talent remains difficult and wages here continue to be significantly higher than those in Toronto and Vancouver. He believes that sometime in the past, wages fell out of line with the rest of Canada and the gap has never closed.

Read: Sanofi survey finds low employer satisfaction with benefits for vision, major dental care

Without a published fee guide, Esmail says there’s no exact science to his method for setting his fees. It has been a few years since he has adjusted his fees, but to determine price points in the past, he has used multiple sources of information, including insurer fee schedules, matrix research polls and information shared with colleagues in the area. In his view, it would certainly be easier if the association published an annual fee guide and he says that in the absence of a fee guide, he’d be in favour of more transparency. But he sees no signs of either things happening.

Some Alberta residents have resorted to dental tourism, travelling to places like Mexico, where the cost savings on certain major dental procedures can help subsidize the cost of a winter vacation. Esmail, however, cautions patients who are considering treatment outside of Canada that dental education and standards may not be on par with Canadian requirements. He says he knows several patients who returned from Mexico with nasty infections from shoddy implant surgeries and notes the cost of the repair work has typically far exceeded what it would have been to get the procedure done in Alberta in the first place.

Read: Understanding the costs of dental benefits

So how can employees save money on dental treatment? In Esmail’s opinion, prevention is the best way to reduce dental costs. Three factors determine dental health: home care, diet and genetics. Flossing and using an electronic toothbrush are the first lines of defence. Avoiding sugar — especially sugary drinks — is one of the best things you can do from a diet perspective to help prevent tooth decay and cavities. Esmail also points out that seemingly healthy foods, like fruit juices and gummy vitamins, can be bad for teeth, especially children’s. Gummy vitamins can stick to teeth, so brushing shortly after consuming these foods can help.

Employees looking to save money can also question whether recommended treatment is urgent or if deferring it can be an option without harming their dental health. When it comes to seeking a second opinion, Esmail suggests employees ask to see the proof (such as X-rays) and should be comfortable that their dentist has clearly explained the need for any treatment as well as any lower-cost options. If the employee isn’t comfortable with what a dentist is saying, it may be prudent to get a second opinion.

Read: Voluntary benefits an emerging option for employers

Since there’s no evidence that dental fees in Alberta will come down or become more transparent any time soon, employers’ best defence against rising costs may be to encourage consumerism and prevention through employee cost-sharing and education.

Kenneth MacDonald is a senior consultant with Morneau Shepell in Calgary. These are the views of the author and not necessarily those of Benefits Canada.
Copyright © 2017 Transcontinental Media G.P. Originally published on benefitscanada.com

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See all comments Recent Comments

Chas:

I saw precious little understanding of consumerism in this article, although it is clearly one of the means to the end of lower out-of-pockets. Insurers and consultants have a conflict of interest when it comes to unregulated professional fees; in other words, given the way profit charges are in essence, cost-pus loaded in rates, and given the way commissions are set, there is no incentive to reduce costs.

An Alberta employer group or a fee-based consultant should do what was done when DIN cost data and dental feet data first became available for purposes of fee analysis. Specifically, do what one enterprising insurer did then, but this time applied to Alberta dental fees: publish the prevailing rates being charged by each Alberta dentist. Filter for the ones charging R and C levels, and publish the names. Said insurer, who had been read the riot act by one of its 10,000+ employee ASO clients, did so for that client’s employees. The employer then sent letters to the top ten treating dentists, advising them that if their fees did not revert statistically to the norm (the fee guide in this case), in the interests of saving their patients their out-of-pockets, they would be encouraged to go to the dentists who were compliant with the guide. Problem solved.

The author’s pass-along rationalization for his dentist’s exorbitant fees did not hold water mathematically or logically.

Tuesday, August 02 at 12:21 pm | Reply

JayC:

Could not agree with you more Chas. Used similar techniques in the maritimes many years ago with some union muscle for emphasis. It has worked well to this day. You could also advertise those BC guide fees for island winter holiday subsidies. Along with Vancouver Island Dentist listings. Recalls a little easier to arrange.
PS Seattle in law had Mexican Dental work done that was a disaster and had to be redone in Seattle. Expensive vacation.

Tuesday, August 02 at 3:13 pm | Reply

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