Dental providers aren't laughing about reimbursement under the federal plan

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OTTAWA — Some dentists and hygienists fear they won't be paid fairly for services under a new federal dental plan, threatening the success of the massive program.

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Each provincial and territorial dental association has its own cost guidelines for dental services based on labor, overhead and material costs in their area.

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The federal reimbursement plan is similar to what the government pays as part of a benefits scheme for First Nations and Inuit people, called the Non-Insured Health Benefits Program, or NIHB.

This program usually pays less than what provincial and territorial guides offer. Covered services also accurately reflect the NIHB plan.

That means dentists may not want to sign up to participate, or patients may end up paying the difference out of pocket, said Dr. Julie Waterbury, president of the Nova Scotia Dental Association.

“If dentists across Canada decide to opt out of this plan, this Canadian dental care plan will not succeed,” Waterbury said in an interview Thursday.

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Reimbursement amounts for the new federal program must be fair to providers and responsible for public funds, said federal officials, who were briefed on condition of anonymity.

So far, the federal government has only released the reimbursement plan for 2023, but updated information for 2024 is said to be available in time for dentists to start claiming reimbursement in May.

In Nova Scotia, the proposed payment for one silver filling in 2023 was $164, but the federal dental plan is proposing to pay just $108.58, Waterbury said.

Private dental insurance plans don't always cover the full costs recommended in provincial fee guidelines, but Dr. Brock Nicolucci, president of the Ontario Dental Association, said they come close.

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“Every procedure is different, but this is much lower than the typical discount for private dental care,” he said.

Nicolucci believes that buy-in from dentists, hygienists and other dental care providers is an important factor.

“If we have a dentist who doesn't want to participate in the program, what happens to the patient?”

In a city with more dentists, that might not be a problem, Nicolucci said, but if a dentist in a rural community doesn't have an appointment, it means the patient has to travel.

The Canadian Association of Dental Hygienists said the discrepancy is even greater for hygienists who do not work in a dental office.

The costs can be passed on to patients through so-called balanced billing, but that's not something the association wants to bear, said Sylvie Martel, the association's director of dental hygiene practices.

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“The reason the plan came together was to alleviate the costs of oral health care,” Martel said.

Fees are expected to evolve and be updated as the program continues, federal officials said.

A program similar to federal dental care insurance was developed as a condition of a deal between the Liberals and the NDP in exchange for the opposition party's support in key votes.

It is expected to cover uninsured families with household incomes of less than $90,000 starting in May, with seniors being the first to be eligible.

The plan is slated to cost $13 billion over five years.

NDP health critic Don Davies says dentists and other oral health care providers should be reimbursed at the same rate as those who treat people with regular employer insurance plans.

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Davis said last week that he doesn't expect dentists to subsidize the federal plan.

More than 600,000 seniors have already signed up and when the program is fully expanded next year, the program is expected to provide coverage to nine million Canadians.

Providers can sign up for service on the plan next month.

Between reimbursements, the expected administrative burden and staffing shortages in dental offices, Waterbury said it's unlikely he'll be registered as a provider.

“This could mean that some of my patients will no longer be able to receive care through me, which I find difficult to deal with,” he said.

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