I am a Dentist in Kitchener, ON, and each week I like to explore a question that I commonly get at my Family Dental office. This week, I'd like to discuss how dental treatment costs are set. Patients often wonder who determines treatment costs and if their is some degree of standardization from office to office. So, let's jump in!
Dentistry is expensive and oftentimes, what determines treatment costs is unclear. Because dental insurance covers much of what we provide, the ins and outs of treatment pricing are rarely questioned and therefore rarely discussed. But, some patients don't have insurance and pay "out-of-pocket". For them, an understanding of how fees are set might be of much greater interest.
Whether a patient is paying for their dentistry or not, I still believe more transparency and more information for patients should be the norm. It's why I write this blog each week. So let's go through a crash course in dental billing so you can better understand treatment costs.
The Ontario Dental Association (ODA) provides an annual fee guide to all licensed/accredited Dental Offices in Ontario. This fee guide outlines the cost of dental cleanings, dental fillings, dental crowns, dental bridges, dentures and more. If you ask your Dentist for the cost of a molar root canal treatment, they will probably page through their ODA Fee Guide to locate the precise cost.
The ODA Fee Guide is also what the insurance companies reference to determine their portion of a given treatment cost. For example, your Kitchener Dentist completes a $240 surgical dental extraction for you and your insurance covers at an 80% reimbursement rate. Your dental insurance will provide $192 (or 80% of $240), and you will be responsible for the remainder, or $48.
Now, Dentists can charge fees that are higher than those set out in the fee guide. While this is very uncommon, it does happen. So, using our example above, if your Dentist charged $300 for the same extraction, your insurance would still only kick in $192 toward the treatment.
There are variations on the simple example provided above. For instance, some Dental Insurance Plans do not use the current Fee Guide when determining treatment costs. It's 2020 and I've already seen a few dental insurance providers that are using fee guides from a few years ago (with lower set fees) to determine their funding for treatment costs. This "lag" often results in patients having to pay more than a standard 10% or 20% co-payment. This is entirely related to your own distinct dental plan coverage and their rules and policies.
Most dental insurance plans also have a yearly or annual maximum amount for coverage they will provide. Your plan, for example, might cover 80% of the cost of treatments up to $1000 each year. So, once they've kicked in $1000 toward treatment for you in a year, you will have exhausted that insurance subsidy. This has nothing to do with fee guides or treatment costs, but is again related to your insurance plan.
The take home here is that:
Treatment costs and insurance coverage are very important to patients when considering dental treatment. While this can be a very dry topic, my hope is to arm you with some basic information about how dental costs are set and how insurance companies subsidize treatment. The overarching principle is that a standard ODA Fee Guide is used by most Kitchener Family Dentists for the purpose of setting their own fees. While some Dentists bill "above the Fee Guide", most do not. Therefore, you are unlikely to find a dramatic difference in fees from one dentist to the next.
The best practice is to know the details of your Dental Insurance Plan. This is not an easy thing to commit to memory. Often times, it is helpful to bring your Dental Plan handbook to the Dental Office for help with interpreting the details of your coverage. This way, you are less likely to encounter unpleasant cost surprises.
I hope you've found this article to be useful. If you have any questions, feel free to contact us at firstname.lastname@example.org. Thanks for reading!
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your Kitchener Dentist or other qualified healthcare provider with any questions you may have regarding a dental treatment and related costs.