A Prince George woman who successfully applied for the federal government’s new dental coverage plan for seniors has been told by her dentist the plan will not be accepted.
Janice Duggan received a letter in the mail from the federal government last month to inform her she qualifies for the Canadian Dental Care Plan, which is available to seniors 70 years and older provided their annual family income does not exceed $90,000.
The letter said she could expect to receive a package from Sun Life Assurance Company of Canada within the next three months which would include a member’s card and details of what’s in the plan.
Duggan went to Hart Dental a couple weeks ago and asked the receptionist about the government plan and was told she would be responsible for paying the full costs of her treatment and that none of the dentists in Prince George have signed up to be providers registered under the new federal insurance policy.
“I asked them about this plan and she said that the dental groups got together in Prince George and basically told me that none of them are going for it,” said Duggan. “I said to her, then if I can’t come to you guys because your dentist isn’t accepting it, can you give me the name of a dentist in town that is accepting this so-called plan and she said they basically aren’t going for it.
"They have their issues with it and that’s why they’re not going to accept it, but we don’t know that.”
Duggan, 74, is not the only one wondering about what the federal program will cover and who will be providing the services.
“Somebody needs to say something, because all of these people think that they’re just going to be able to go to their dentists and get their plan and everything will be fine,” said Duggan. “I think that’s misleading.
“I don’t have a dental plan and have to pay cash every time I go, so we were excited about getting this, but you’re not really getting it if these dentists are not accepting it.”
The program is not intended as a replacement for existing dental benefits offered through employer/pension-sponsored or private plans but will fill in existing gaps in coverage for people who are not insured. The government claims the $4.4 billion program plan will cover as many as nine million Canadians over the next five years, providing up to 100 per cent of eligible dental care service costs to local providers, but that won’t cover the full cost.
While dentists in Prince George follow the British Columbia fee guide, the federal plan has its own fee structure to determine cost of procedures and patients will be responsible for paying a portion of the costs.
“What has been put out to the public as far as the coverage is totally not true,” said Leanne Foy, practice manager of Timber Ridge Dental in Prince George. “What they’ve sold to the public is that this is free dental and it’s no where close to being free dental, unfortunately. That’s why there’s frustration from patients who are signing up and phoning around, saying they have free dental now, and we have to give them the bad news.’
Patients are eligible for 100 per cent coverage of the CDCP fee rate, provided the net family income is less than $70,000. A patient’s whose family income is between $70,0000 and $79,999 will receive 60 per cent fee coverage, while those who make between $80,000 and $89,999 will get 40 per cent coverage.
The CDCP fee guidelines are significantly lower than BC fee rates for procedures.
As an example, Foy said in the case of tooth extraction that costs $160, the government fee for that service is only $50, of which the plan would cover only a percentage of that.
The federal plan also limits frequency. For people who need to have their teeth professionally cleaned, the CDCP only covers that once every 12 months, when many seniors require that every six months to maintain oral health.
According to the government website, "Oral health providers are encouraged to follow the CDCP established fees, which are not the same as the provincial and territorial fee guides, so that their patients do not face additional charges at the point of care.”
That would mean participating dentists would be forced to write off those additional charges.
Several procedures have to be pre-authorized by the administrators of the plan, but Foy says they are not accepting any pre-authorizations until Nov. 1. While providers who submit claims electronically should be reimbursed within several day by the insurer, Sun Life Financial, providers have also been told they most likely would also have to wait until November to receive payments for paper claims submissions.
The graduated application process was first applied in December to people aged 87 or older and in March seniors aged 70-71 could apply. By May, when the program is in effect, it will be open to anybody aged 65 or older.
For oral health providers, participation in the Canadian Dental Care Plan is voluntary. Few details were released in advance of the March 11 deadline for dentists to register and that uncertainty prompted the BC Dental Association to recommend that they not sign up as plan providers.
“The problem is that basically the dentists are being told by the government that in order to take patients and for us to bill the Canadian Dental Care Plan, dentists have to register for it,” said Foy.
“There hasn’t been a whole lot of information released to dentists and they won’t give any more information until you register. They haven’t been totally honest and transparent and a lot of dentists are leery of signing up.
“We’re getting lots of people phoning around and it is confusing. It’s confusing for us because we haven’t been getting all the facts. Until those facts are better explained to dental offices and dentist/owners they’re not going to register for something they don’t what they’re getting involved in.”
