Understanding your dental benefits
Your dental claims are paid according to either the Alberta Blue Cross Dental Schedule® or the Alberta Blue Cross® Usual and Customary Dental fees.
What is the Dental Schedule?
The Alberta Blue Cross Dental Schedule® is a basis of payment for dental claims. Every year, the schedule is updated with new rates so that it continues to provide a consistent basis of payment for your dental claims. The Dental Schedule takes into account the costs associated with operating a dental practice as well as economic indicators, and remains comparable to rates for similar procedures in current provincial suggested dental fee guides published in British Columbia, Saskatchewan and Manitoba.
What are the Alberta Blue Cross® Usual and Customary Dental fees?
The Alberta Blue Cross® Usual and Customary Dental (U&C) fees are a basis of payment for dental claims that is aligned with the Alberta Dental Association (ADA) Dental Fee Guide.
The ADA developed a provincial fee guide to begin to create a standard rate for dental services throughout Alberta. It does this by outlining suggested fees for individual dental procedures. These fees can be found on the ADA site.
It is important to note that dentists are not required to follow these fees and that, because there is no standard of billing of dental services in Alberta, dental offices across Alberta charge varying amounts for dental services. If U&C fees are the basis of payment for your dental plan, we recommend asking your dentist if they charge according to the ADA Dental Fee Guide to see if they will be charging what your plan pays.
Usual and Customary Dental fees do not apply to plans that reference the Alberta Blue Cross Dental Schedule®.
How much will you be charged?
There is no standard for the billing of dental services in Alberta, which means dental offices may charge widely varying prices for dental services. If your dental office charges more than your plan covers, you will be billed the difference.
Checking your coverage
Most dentists are able to electronically submit a predetermination to Alberta Blue Cross® prior to your appointment. This allows your dental provider to check how much your plan pays for dental procedures and how much, if anything, you would have to pay out-of-pocket. Ask your dentist about this service.
All Alberta dental offices have quick and easy access to information about your dental coverage through CDAnet™.
I have 100 per cent coverage for dental check-ups and cleanings, but I still end up with out-of-pocket expenses. Why?
Because there is no standard billing of dental services in Alberta, dental providers can and often will charge more than what your plan pays.
If your plan states that you have 100 per cent dental coverage, your plan will pay 100 per cent of the Dental Schedule or Usual and Customary rates, but not necessarily 100 per cent of what the dentist charges. You will be required to pay the difference if there is one.