How Do Dentists...

How Do Dentists Set Their Fees?

In Alberta, dental fees are not regulated. There is also no fee guide put out by the Alberta Dental Association and College. Some provinces have fee guides put out by their dental colleges but the dentists are still free to set their own fees. Many provinces are under scrutiny by the Competition Bureau of Canada because their fee guides impede “the maximum possible benefits of competition to consumers.”

This leaves dentists and dental hygienists with the problem of setting their own fees. Most dentists will determine their fees based on the fees of their competitors in their local market and the cost of doing business (staff, rent, equipment, supplies, insurance, regulatory fees, office supplies etc.) This is a difficult task because dentists are healthcare providers and are not necessarily good business people. If you compare dental fees in a particular area, you’ll find that they vary between clinics. A clinic may charge above the average price for one procedure but below the average price for another.

One problem with dental billing is that every insurance company has their own fee guide. Each insurance company will pay a different amount than others will for the same procedure. Unfortunately, most insurance companies won’t tell dental clinics what they will pay for each procedure (even if the dental clinic asks). Some insurance plans pay far less than others do. To make matters worse, insurance companies generally change their fee guides every year.

Some dental insurance companies sell “discount” plans that cost less month to month but pay a smaller amount for a procedure than a regular plan would pay. Beware of these discount plans. You will end up paying more out of your pocket since legally a dentist must charge everyone the same price for the same procedure no matter which insurance plan they have.

Sun City Dental tries to set their fees in the most “Insurance Friendly” way. If insurance company A will pay $80 for a procedure and company B will pay $78, we charge every patient $78. By law, however, we are required to collect your co-pay i.e. whatever your plan didn’t cover when you have less than 100% coverage (even if the co-pay is only $2). At Sun City Dental we direct bill. This means your insurance company pays us directly and you pay the co-pay, rather than paying for the whole procedure upfront.

Sun City Dental strives to charge the same fees that your insurance company will pay. If you have 100% coverage for a procedure, under most plans and for most procedures, there will be nothing to pay out of pocket.

Understanding dental insurance is difficult when policies between companies are so different. To help you, we have experienced dental receptionists that can explain the process and allow you to make a decision that is right for you.