Handbook. Your guide to the Alberta Blue Cross. Dental Schedule

Transcription

1 Dental Handbook 2016 Your guide to the Alberta Blue Cross Dental

2 Alberta Blue Cross Dental : 2016 Helping you keep your healthy smile About the schedule January April February May March June This handbook provides an informative reference guide for the Alberta Blue Cross Dental including a list of the maximum amounts your plan will pay for the most common dental procedures. Please refer to this schedule prior to your dental appointments. July October August November September December Important note Coverage for specific dental procedures varies depending on your particular plan design. Some procedures listed in this book may not be covered by your particular dental plan. Please consult your plan contract or benefit booklet for more information. 1

3 Why a dental schedule? In Alberta, individual dental providers are able to set their own prices. This situation differs from that in many other provinces where dentists follow a fee guide established by provincial dental associations. As a result, dental offices across Alberta charge widely varying prices for dental services. In some cases, consumers are able to negotiate lower prices for dental services. In other cases, a portion of each dental visit may not be covered regardless of the level of coverage provided through the dental plan. The Alberta Blue Cross Dental provides our plan members with a consistent and reasonable basis for payment of dental claims. The amounts are established by analyzing other provincial dental associations' fee guides, economic factors and what is deemed reasonable in the current market. Dental Handbook 2016 Your dental provider has quick and easy access to information about your dental coverage electronically through CDAnet and DACnet. The Dental Handbook This handbook lists the maximum amounts your plan allows for many common dental services. Your eligibility for coverage of specific procedures depends on your particular plan design. Some procedures listed in this book may not be covered by your particular plan. All Alberta dental offices have access to the 2016 Alberta Blue Cross Dental. 2 3

4 Understanding your dental schedule Keeping your plan affordable The Alberta Blue Cross Dental exists to provide you quality dental benefits while keeping your plan viable and affordable. Each year, payment amounts are established that are reasonable and in most cases are equal to or higher than other western provinces. The dental schedule allows you to have dental coverage through a viable, economical benefit plan. It s important to understand that your plan pays dental expenses according to the Alberta Blue Cross Dental. This means that if your plan states you have 100 per cent dental coverage, your plan will pay 100 per cent of dental schedule amounts, not necessarily 100 per cent of what the dentist charges. As fees for dental services in Alberta are set by each dentist, and in many cases are rising at levels beyond inflation, if Alberta Blue Cross were to simply pay what each individual dentist billed, your dental plan rates would have to be increased substantially. Over time, this would make your benefit plan unaffordable. 4 5

5 Make the most of your dental schedule Be sure to notify your dental office that your dental coverage is paid according to the Alberta Blue Cross Dental, and verify whether you will be charged for dental services according to these amounts. If your dental provider charges more than what your dental plan allows, you may face out-of-pocket costs. To make it easier to have a discussion about the amount charged for dental services, please show your Alberta Blue Cross ID card to ensure your dental office has your correct coverage information. You may also cut out the quick reference card on the back cover of this handbook and present it at your dental appointment. Should your dental provider bill more than your dental schedule, you will be responsible for paying the difference. You do have the following options: You can negotiate a better price for dental services. You can agree to pay any extra amount billed beyond what the Alberta Blue Cross Dental pays. You can access services from another dental provider, or consider using a different provider in the future if you have already had your dental work completed. You will still be required to pay any applicable co-pay or deductible amounts (where applicable) at the time of your appointment. Decisions about treatment remain between you and your dental provider. 6 7

6 Enjoy the advantages of direct billing Alberta Blue Cross plan members and dental providers benefit from the convenience of direct assignment billing. When your dental provider bills Alberta Blue Cross directly for services covered by your plan, you don t have to pay the entire cost up front. You will still be responsible for payment of any co-pay or deductible amounts. This also helps your dental provider reduce administration costs and receive payment promptly. Today, most general practitioner dentists and denturists bill Alberta Blue Cross directly for patients dental claims. you don t have to pay the entire cost up front, and your dental provider receives payment promptly. Dental providers make the choice whether or not to bill Alberta Blue Cross directly. Before your next dental appointment, confirm that your dental office accepts assignment billing and uses online claims submission. 8 9

7 Comparing prices On the pages that follow are costs for some common dental procedures. There s also a comparison with other western provinces that shows the Alberta Blue Cross Dental amounts are comparable to the 2015 provincial dental associations General Practitioners fee guides in, and, for similar procedures. Your dentist can quickly check how much your plan pays for dental procedures and how much, if anything, you will have to pay by submitting a predetermination to Alberta Blue Cross prior to your appointment. Be sure to ask your dentist about this convenient service. Coverage for specific dental procedures varies depending on your particular plan design. Please consult your plan contract or benefit booklet for more information. Or, learn more about your benefit details by signing into our member services web site by going to and clicking "Sign in". The 2016 Alberta Blue Cross Dental offers plan members good value through a benefit plan that contains viable, affordable dental coverage

8 Offering value Typical annual checkup for adults The Alberta Blue Cross Dental takes into account the costs associated with operating a dental practice and is a well-researched and credible basis for payment of your dental claims. The dental schedule is reviewed on an annual basis to ensure it continues to meet the needs of all concerned. This review considers a wide variety of economic factors, as well as feedback from both dental providers and our plan members. Each year, the dental schedule fee amounts are increased to appropriately reflect the economy, dental expenses and other factors, while still ensuring reasonable benefit plan rates. Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and Recall exam Procedure bitewing radiographs Procedure time units scaling Procedure time unit polishing Procedure Fluoride Procedure Alberta Blue Cross Dental $52.30 $27.60 $33.00 $31.60 $29.30 $23.60 $30.00 $26.20 $ $65.80 $74.00 $98.00 $44.20 $34.10* $34.00* $38.20 $19.70 $13.80 $21.00 $18.30 Total $ $ $ $ *no longer based on units of time 12 13

9 Typical annual checkup for children Restorations (fillings) Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and Alberta Blue Cross Dental Each person has unique dental needs, so your dental treatment may be different from the examples shown here. Please note that some procedures listed in this book may not be covered by your particular dental plan. Recall exam Procedure bitewing radiographs Procedure time unit scaling Procedure time unit polishing Procedure Fluoride Procedure $52.30 $27.60 $33.00 $31.60 $29.30 $23.60 $30.00 $26.20 $53.00 $32.90 $37.00 $49.00 $44.20 $34.00* $34.00* $38.20 $19.70 $13.80 $21.00 $18.30 Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and 4 surface amalgam (silver) filling permanent molar Procedure pins for filling Procedure Alberta Blue Cross Dental $ $ $ $ $43.90 $45.80 $40.00 $35.50 Total $ $ $ $ Total $ $ $ $ *no longer based on units of time 14 15

10 Crown procedures Three unit bridge procedures Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and Porcelain fused to metal crown Procedure Alberta Blue Cross Dental Root canal therapy $781.60* $740.00* $728.00* $702.70* Post cast metal Procedure $168.90* $125.00* $182.00* $168.70* Total $ $ $ $ *plus lab fees Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and 3 root, root canal therapy Procedure Alberta Blue Cross Dental Dentist's fees only: all fees have additional lab charges. $ $ $ $ Alberta Blue Cross Dental comparison to the 2015 provincial dental associations general practitioner fee guides in, and Retainer, (crown) for fixed bridge * Procedure Alberta Blue Cross Dental Coverage for specific dental procedures varies depending upon your particular plan design. Some procedures listed in this book may not be covered by your particular dental plan. Please consult your plan contract or benefit booklet for more information. Dentist's fees only: all fees have additional lab charges. $743.40* $692.00* $664.00* $715.70* Retainer, (crown) for fixed bridge * $743.40* $692.00* $664.00* $715.70* Procedure Pontic, for fixed bridge (to replace missing tooth) $332.80* $318.00* $330.00* $345.30* Procedure Total $1, $1, $1, $1, *plus lab fees 16 17

11 Examples of denturist fees Procedures Professional fee Denture services Regardless of your age, dentures are a viable option to replace missing teeth. Denturists are independent dental professionals who examine, diagnose and treat patients who require dentures. They usually offer their services from denture clinics, which function independently of dentists. In Alberta, denturists have expanded duties and provide complete or partial denture services. General prosthodontic exam Procedure Complete upper denture Procedure Complete lower denture Procedure Partial upper denture Procedure Complete upper denture repair Procedure Complete upper denture reline (processed) Procedure *plus lab fees Not all procedures listed in this book may be covered by your plan. Consult your plan contract or benefit booklet for more information. $66.50 $659.70* $659.70* $702.60* $60.00* $198.80* 18 19

12 Examples of common dental procedures Compared to 2015, and Dental Association Fee Guides for General Practitioners. Coverage for specific dental procedures varies depending upon your particular plan design. Some procedures listed in this book may not be covered by your particular dental plan. Please consult your plan contract or benefit booklet for more information. Procedure code Description Alberta Blue Cross Dental Complete examination (new patient all permanent teeth) $ $90.80 $ $ Limited new patient examination $52.30 $41.50 $43.00 $ Recall examination (checkup) $52.30 $27.60 $33.00 $ Specific examination $52.30 $35.50 $41.00 $ Emergency examination $52.30 $51.90 $50.00 $ Full set of X-rays $ $94.50 $ $ X-ray (periapical) $20.20 $17.30 $22.00 $ X-rays (periapical) Offering value $29.30 $23.60 $30.00 $ X-rays (periapical) $38.40 $30.10 $38.00 $ X-rays (periapical) $47.40 $36.60 $47.00 $ X-rays (bitewing) $29.30 $23.60 $30.00 $ X-rays (bitewing) $47.40 $36.60 $47.00 $ Panoramic (whole mouth) X-ray $74.70 $65.30 $68.00 $ Polishing (up to 15 minutes) $44.20 $34.10* $34.00* $38.20 *no longer based on units of time 20 21

13 Examples of common dental procedures (continued) Procedure code Description Alberta Blue Cross Dental Scaling (removal of tartar, up to 15 minutes) $53.00 $32.90 $37.00 $ Scaling (removal of tartar, up to 30 minutes) $ $65.80 $74.00 $ Scaling (removal of tartar, up to 60 minutes) $ $ $ $ Fluoride $19.70 $13.80 $21.00 $ Pit and fissure sealant (first tooth) $29.80 $26.10 $27.00 $ Pit and fissure sealant (each additional tooth same area) $14.90 $14.40 $18.00 $ surface amalgam (silver) filling primary tooth $ $ $ $ surface amalgam (silver) filling primary tooth $ $ $ $ surface amalgam (silver) filling permanent anterior tooth/bicuspid $ $ $ $ surface amalgam (silver) filling permanent anterior tooth/bicuspid $ $ $ $ surface amalgam (silver) filling permanent molar $ $ $ $ surface amalgam (silver) filling permanent molar $ $ $ $ pin for filling $31.60 $30.40 $26.00 $

14 Examples of common dental procedures (continued) Procedure code Description Alberta Blue Cross Dental Two pins for filling $43.90 $45.80 $40.00 $ Stainless steel crown primary tooth $ $ $ $ surface composite (white) filling permanent anterior tooth $ $ $ $ surface composite (white) filling permanent anterior tooth $ $ $ $ surface composite (white) filling permanent bicuspid $ $ $ $ surface composite (white) filling permanent molar $ $ $ $ surface composite (white) filling permanent molar $ $ $ $ surface etched composite (white) filling primary posterior tooth $ $ $ $ Porcelain fused to metal crown $781.60* $740.00* $728.00* $702.70* Metal (gold) crown $781.60* $698.00* $728.00* $702.70* Lab processed veneer $569.00* $740.00* $573.00* $528.00* Recementation of a crown (up to 15 minutes) $74.70* $71.70* $109.00* $72.60* Root canal therapy (one root) $ $ $ $

15 Examples of common dental procedures (continued) Procedure code Description Alberta Blue Cross Dental Root canal therapy (three roots) $ $ $ $ Root planing (removal of tartar, etc. from roots; up to 15 minutes) $53.00 $32.90 $37.00 $ Root planing (removal of tartar, etc. from roots; up to 30 minutes) $ $65.80 $74.00 $ Complete upper denture $729.90* $738.00* $909.00* $723.70* Pontic for fixed bridge (to replace missing tooth) $332.80* $318.00* $330.00* $345.30* Retainer (crown) for fixed bridge $743.40* $692.00* $664.00* $715.70* Uncomplicated tooth removal (first tooth) $ $ $ $ Uncomplicated tooth removal (each additional tooth in same area) $77.20 $77.40 $86.00 $ Surgical tooth removal (first tooth soft tissue coverage) $ $ $ $ Tooth removal complete bone coverage $ $ $ $ Not all procedures may be covered by your plan. Consult your plan contract or benefit booklet for more information. *plus lab fees 26 27

16 Record of appointments Date: Patient: Name of dentist: Service performed: Date: Patient: Name of dentist: Service performed: Date: Patient: Name of dentist: Service performed: The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan. ABC 83448_handbook 2015/12 Date: Patient: Name of dentist: Service performed: 28 29

17 Call us for more information about the Alberta Blue Cross Dental Edmonton and area Calgary and area Grande Prairie Lethbridge Medicine Hat Red Deer toll free Please present this card to your dental office prior to your appointment. 30 This dental plan pays according to amounts listed in the Alberta Blue Cross Dental. For more information regarding Alberta Blue Cross Dental amounts and eligible benefits, please check this patient s plan details through CDAnet or contact Alberta Blue Cross Dental Services.