I’ll be discussing fees with my dentist

Price pains will remain until more clients talk to their dentists about reducing rates

My next appointment at the dentist is still a couple of months away, but already I’m planning on a different approach to the visit.

Much to the chagrin of my hygienist, I’m not talking about an upsurge in my flossing performance, but rather an overdue conversation that needs to happen. You see, I like the atmosphere in the dental office and the quality of care. Yet I haven’t bothered to ask whether the fees my dentist charges are low, average or high compared with his colleagues.

I can do that now, because a year ago Alberta finally introduced — for the first time in two decades — a fee guide that offers patients some idea of the rates they should expect to pay.

The fees laid out in the guide are recommendations only. Dental work isn’t covered by the province’s health-care system, which means dentists are free to set their own rates.

A provincial review released in 2016 showed that while those rates were all over the place, Albertans were generally subject to some of the highest costs in the country. The Alberta Dental Association and College and Health Minister Sarah Hoffman agreed last November on a fee guide that called for an 8.5 per cent reduction in average prices for cleanings, fillings and other common services.

The idea was to create pressure for dentists to lower rates and rein in some of the practices that were outliers in the system.

In the year since its introduction, has the guide worked?

The answer is mixed, much like a checkup that finds fewer cavities but also the persistence of inflammation.

Billing records show 30 per of the province’s 2,350 general dentists are now charging rates at or below the fee guide for the 10 most common procedures. That’s up from six per cent a year ago.

A survey conducted by the association and college found the median value of fees charged by dentists is still above the recommended rates. However, 63 per cent of the respondents are now charging at or below that median value, up from 57 per cent last year. To association and college president Dr. Tony Odenbach, this indicates there has been a “coalescence” toward the fee guide. In another survey, he says dentists reported a decline in profits over the past year because of the guide.

“Dentists of Alberta have done their part to control their costs of delivery,” Odenbach said.

I’m not sure I agree. Overall, the numbers show there has been some progress at making prices more reasonable.

Yet it’s also fair to conclude there is more drilling down that needs to occur. Hoffman told me this week that more work indeed lies ahead, but wasn’t offering details. The 2019 fee guide will keep rates frozen, but beyond that it’s unclear if the province is contemplating more aggressive action.

The most compelling question is around those 70 per cent of dentists who have yet to meet the guide. Many have said they have little room to reduce rates because of high office expenses, including that Alberta dentists are subject to the most stringent (and most costly) sterilization standards in the country.

As well, like many health professionals in Alberta, dental assistants and hygienists are typically paid more than their counterparts in other provinces.

Odenbach says dentists have been worried about losing staff, and are consequently reluctant to impose reductions in pay or hours. Those concerns are legitimate, yet it’s also clear a substantial number of dentists have found ways to tighten their belts.

I suspect several others are still in wait-and-see mode, trying to determine how much pressure they really face to reduce rates. As private business owners, that is their right.

Odenbach also maintains that the biggest beneficiary of the fee guide has been the insurance companies used by employers to manage dental benefit plans.

Most companies don’t publicize their coverage rates, but Odenbach says dentists have reported that the firms quickly adopted the fee guide as the maximum they would pay.

That means some patients are actually paying more for dental work. Take the example of a dentist who is charging $84 for a basic exam. A patient’s benefit provider perhaps used to cover all of that fee, but is now covering only up to the fee guide rate of $64 — leaving the patient to pay the remaining $20.

Ultimately, the new guide will only be as successful as the public’s appetite to use it as the tool it was intended to be.

If we want to see prices fall, more Albertans will need to have conversations with their dentists like the one I plan to have.

At least then you can make an informed decision about the value of what you’re paying for.

Having that knowledge, even more than a cleaning or fluoride treatment, should give Albertans reason to smile.