Alberta's NDP government will create a dental fee guide

[Fuzz]

So how do you know when to start and stop the clock on scaling time? Is it only the scraping, or does it include the polishing and fluoride?

[Dentoman]

Originally Posted by iggy_oi

Sorry had to fix that part.

Definitely agree though with it being a good thing for plans to be cheaper by not allowing dentists to gouge insured patients.

I would bet plans would not be significantly cheaper. Insurance companies have not changed the yearly maximum benefit amount (usually $1500) for a long time. Their actual "skin in the game" has not changed.

[Ducay]

Originally Posted by Mr.Coffee

Ducay, could you please film your next conversation with your dentist or the cashier when you go to pay, and begin accusing them of insurance fraud based on what you'd read from Dentoman on the internet?

No offence to Dentoman, but I think watching that conversation would be a blast.

"NO I only owe you TWO units. Dentoman said so."

"Listen lady, I swear I'm right, give me 5 minutes to flash the Dentoman signal and he'll be here in the Dent-mobile."

[Dentoman]

Originally Posted by Fuzz

So how do you know when to start and stop the clock on scaling time? Is it only the scraping, or does it include the polishing and fluoride?

Polishing and fluoride are separate. Scaling is the "scraping" and the ultrasonic (probably called the Cavitron).

[STAMPEDRED]

Originally Posted by Erick Estrada

My last cleaning was $325 and that didn't involve x-rays or check by the dentist. $325!!!!! This madness has to stop. I have my work coverage and my wife's and between them I don't pay anything but I have no idea how less fortunate families can handle this type of gouging as it's just ridiculous what Alberta dentists have been charging.

.... somebody needs to brush their teeth more than once per year!!

In actuality, you would think if people took good care of their teeth as well as their diet, you would be fine. It's gotta be a disgusting job being a dentist knowing the amount of junk food people put in their mouths and depending on how well they take care of their teeth as well. I would charge high rates for that too!

[Locke]

Originally Posted by Fuzz

So how do you know when to start and stop the clock on scaling time? Is it only the scraping, or does it include the polishing and fluoride?

My dentist has one of those 'Chess Clocks.'

[GreenLantern]

Originally Posted by Top Shelf

The Dental system in this province is corrupt and a massive frustration. $5000 for an implant? $12,000 for braces? Who the hell can afford this? Only a small percentage is even covered by benefits...such BS

According to a recent poll, a large portion of the posters on this forum! One less ivory back scratcher for the CP faithful.

[NuclearFart]

Originally Posted by Dentoman

Interested to know how you know this to be true. It has never been that way in my office and since the majority of dentists don't take assignment of benefits, I would highly doubt that the majority of dentists would do so ..... in fact, it is insurance fraud to do so. Since an insurance audit could take place at any time, the likliehood of a two tiered fee structure would be highly unlikely.

Well I'm not a dentist so I will never know the whole truth, but its my own anecdotal opinion based what I have seen and heard from others.

Of course dentists wouldn't be so stupidly blatant to have an official two tiered billing structure, but it is easily done within the system by manipulating which codes they chose to charge as has been already alluded to in this thread. Maybe not in your practice, but it would certainly appear that some downtown practices are rather "generous" in their baseline billing structure when they know 99% of their clients are going to have coverage and won't question it.

My suspicion is that the default billing structure told to the front office staff would change rather drastically if the government were involved, becoming more in line with that seen in a medical practice.

[Knut]

Dr Dentoman - What is the highest you have seen Saliva squirt while you were working on someones mouth? I have a feeling those crazy bright spotlights need to be cleaned on a regular basis.

[Dentoman]

Originally Posted by NuclearFart

Well I'm not a dentist so I will never know the whole truth, but its my own anecdotal opinion based what I have seen and heard from others.

Of course dentists wouldn't be so stupidly blatant to have an official two tiered billing structure, but it is easily done within the system by manipulating which codes they chose to charge as has been already alluded to in this thread. Maybe not in your practice, but it would certainly appear that some downtown practices are rather "generous" in their baseline billing structure when they know 99% of their clients are going to have coverage and won't question it.

My suspicion is that the default billing structure told to the front office staff would change rather drastically if the government were involved, becoming more in line with that seen in a medical practice.

Forensic audits conducted by insurance companies will find the billing discrepancies if they are there ... and they have done so resulting in significant penalties to the dentist.
Insurance companies also will do a "code audit" on all of their claim submissions and see if a particular provider is using it more than the average .... once again, leading to a request for further information or an audit.
It is not as "easily done" as you might think.

[NuclearFart]

Originally Posted by Dentoman

Forensic audits conducted by insurance companies will find the billing discrepancies if they are there ... and they have done so resulting in significant penalties to the dentist.
Insurance companies also will do a "code audit" on all of their claim submissions and see if a particular provider is using it more than the average .... once again, leading to a request for further information or an audit.
It is not as "easily done" as you might think.

Appreciate the reply.

How often are these audits actually done? How effective are they in determining abuse of day to day things like the simple example in this thread of over charging the scaling units?

Do you think that insurance companies are doing a better job policing these issues rather than the government?

[Dentoman]

Originally Posted by NuclearFart

Appreciate the reply.

How often are these audits actually done? How effective are they in determining abuse of day to day things like the simple example in this thread of over charging the scaling units?

Do you think that insurance companies are doing a better job policing these issues rather than the government?

I can't speak to how often they are done but I know they are done. I believe the insurance company would run through their database and then examine the abnormalities. They could do a simple phone call or request an audit based on the abnormalities.
I would definitely think an insurance company does do a better job policing this than the government. Insurance companies are not in the business of paying out money that they aren't required to ..... they haven't increased the yearly allowable limit in a long time, despite the increase in fees. They have systems already in place to detect billing abnormalities.

Running a dental practice is expensive. The overhead numbers listed in the government report are realistic. Wages are significantly more costly in Alberta. The tax regime in Alberta is not as favorable toward health professionals as they are in other provinces .... which you would know. All these add up to higher fees, and unfortunately, potential abuse of the system to make up the difference ... but there are mechanisms in place to detect and punish the abuse, and abusers do get punished.

I just hope the rumours of professional corporation changes are not true (where you are required to have a minimum number of employees).

[iggy_oi]

Originally Posted by Dentoman

I would bet plans would not be significantly cheaper. Insurance companies have not changed the yearly maximum benefit amount (usually $1500) for a long time. Their actual "skin in the game" has not changed.

Group benefit plan rates go up based on usage, if you are constantly maxing out your benefits the costs will go up.

[Locke]

Originally Posted by iggy_oi

Group benefit plan rates go up based on usage, if you are constantly maxing out your benefits the costs will go up.

And yet theres no disincentives to racking up your benefits.

Use your benefits this year or you lose them.

[iggy_oi]

Originally Posted by Locke

And yet theres no disincentives to racking up your benefits.

Use your benefits this year or you lose them.

While that is true, I think there's a bigger chance of someone not maxing them out if it is actually possible. There are limits to the number of services you can have done on most plans so it's not as if in the event you need no extra work done that you have 4 or 5 cleanings per year to max out

[Locke]

Originally Posted by iggy_oi

While that is true, I think there's a bigger chance of someone not maxing them out if it is actually possible. There are limits to the number of services you can have done on most plans so it's not as if in the event you need no extra work done that you have 4 or 5 cleanings per year to max out

I'm actually talking specifically about glasses. My wife is going to go out and buy glasses tomorrow specifically because she can/more or less has to.

[Dentoman]

Originally Posted by iggy_oi

While that is true, I think there's a bigger chance of someone not maxing them out if it is actually possible. There are limits to the number of services you can have done on most plans so it's not as if in the event you need no extra work done that you have 4 or 5 cleanings per year to max out

I get your point, but even in the fee guide days, it was not unusual for a significant number of patients to max out their benefits.
The hard cap of $1500 hasn't changed in probably 20 years at least. IMO, people aren't really getting the value for their increase in premiums. The cap on benefits hasn't even adjusted for inflation.

[Northendzone]

Insurance companies are generally pretty tight lipped on their claims audit procedures, or any details other than some stats on delisted practitioners etc.

Given that the insurance companies have actuaries on staff, they likely have very robust algorithms to help them find claims submission patterns.

Generally speaking, a limit of $1500 annually on basic dental services is still pretty rich as most of my clients are averting annual dental costs of around $1,300 per employee - which inludes all services for all employees some of which will be single, while others have families. So I am going to,disagree with dentomans staement.

You will likely hit limits if you incur major dental services. Even then the big part of out of pocket costs is due to the 50 or 60% coin surface that generally applies to major dental work.

Once again, it is generally not the insurance companies that controls the max, it is the sponsor of the plan - if you wanted a maximum of $5,000 you could likely get it, but the initial rates will be high due to expected utilization.

Most people generally do not max out thier dental plans unless they incur orthodontic services.

[Northendzone]

Originally Posted by Locke

I'm actually talking specifically about glasses. My wife is going to go out and buy glasses tomorrow specifically because she can/more or less has to.

Does she have access to funds in a health spending account? If so then there is some urgency to incurring the claim by the end of the year, if not then the maximum for glasses is generally on a two year basis, so if she is at the end of a two year cycle, then getting glasses by the end of the year makes sense.

[Locke]

Originally Posted by Northendzone

Does she have access to funds in a health spending account? If so then there is some urgency to incurring the claim by the end of the year, if not then the maximum for glasses is generally on a two year basis, so if she is at the end of a two year cycle, then getting glasses by the end of the year makes sense.

1. No.
2. Yes.