Dental providers unhappy with reimbursement under federal plan

OTTAWA – Some dentists and hygienists fear they won’t be paid fairly for services under a new federal dental plan, and worry it could jeopardize the success of the massive program.

Each provincial and territorial dental association has its own guide to how much dental services cost, based on labor, overhead and material costs in their regions.

The federal reimbursement plan closely resembles what the government pays as part of its First Nations and Inuit benefit plan, called the Uninsured Health Benefits, or NIHB, program.

That program typically pays less than what is recommended by provincial and territorial guidelines. Covered services also closely reflect the NIHB plan.

That means dentists may not want to sign up to participate, or patients may have to pay the difference out of pocket, said Nova Scotia Dental Association president Dr. Juli Waterbury.

“This Canadian dental care plan will not be successful if dentists across Canada decide to opt out of this plan,” Waterbury said in an interview Thursday.

Reimbursement amounts for the new federal program must be fair to providers and responsible with public funds, said federal officials who provided the information on the condition that they not be named.

So far, the federal government has only released its reimbursement plan for 2023, but says updated information for 2024 will be available in time for dentists to start claiming reimbursement in May.

In Nova Scotia, the suggested rate for a single silver filling in 2023 was $164, but the federal dental plan proposes paying just $108.58, Waterbury said.

Private dental insurance plans also don’t always cover the full costs recommended in provincial rate guides, but Ontario Dental Association president Dr. Brock Nicolucci said they’re closer.

“Every procedure is different, but it is much lower than what normal private dental care benefits provide,” he said.

Nicolucci argued that getting buy-in from dentists, hygienists and other dental care providers is an important factor.

“If we have a dentist who doesn’t want to participate in the program, what happens to the patient?”

It may not be a problem in a city with many dentists, Nicolucci said, but if a dentist in a rural community doesn’t sign up, that means the patient would be forced to travel.

The discrepancy is even greater for hygienists who don’t work in a dentist’s office, the Canadian Association of Dental Hygienists said.

Costs will likely be passed along to patients in what’s called balanced billing, but that’s not something the association wants to encourage, said Sylvie Martel, the association’s dental hygiene practice director.

“The reason the plan was put together was to alleviate the cost burden of providing oral health care,” so that the cost would not deter people from treating their teeth, Martel said.

Federal officials say the rates are expected to evolve and be updated as the program progresses.

A federal insurance-like program for dental care was developed as a condition of a deal between the Liberals and the NDP, in exchange for the opposition party’s support in key votes.

It is expected to provide coverage to uninsured families with household incomes less than $90,000 starting in May, and seniors will be the first to be invited to participate.

The plan is expected to cost $13 billion over five years.

NDP health critic Don Davies says dentists and other oral health care providers should receive compensation equivalent to what they receive when treating people on regular insurance plans provided by their employers.

Davies said last week that he doesn’t expect dental professionals to subsidize the federal plan.

More than 600,000 seniors have already signed up and the program is expected to cover up to nine million Canadians when it fully expands next year.

Providers will be able to sign up to provide services under the plan next month.

Between the reimbursements, the expected administrative burden and existing staffing shortages at dental offices, Waterbury said she is unlikely to sign on as a provider.

“It could mean that some of my current patients will no longer be able to access care through me, and that is very difficult for me to deal with,” he said.

This report by The Canadian Press was first published Jan. 8, 2023.


Leave a Comment