A year and a half ago, Roberta Hardern of St. Albert, Alta., travelled to Los Algodones, Mexico, for dental work. The neighbouring town of Yuma, Ariz., has dental offices on every corner and is a popular destination for Canadians who need major dental procedures but have tight budgets.
For $8,500, Hardern received 28 new dental crowns and two root canals, lodging for a week and transportation between the hotel and Yuma airport. The cost of the dental procedures alone would have been three or four times that amount in Canada, says Hardern. “It was so convenient and so cheap. . . . I highly doubt you’re going to get much of a bargain, [even] if you go to another province.”
Hardern found the quick turnaround time for the work appealing. She would have needed to attend about 15 appointments for the root canals and dental crown procedures in Canada but she was able to get through all of them in three long dental visits in Mexico.
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Hardern’s experience isn’t unusual, as many Canadians make the trip to Mexico for cheap dental procedures. The trend is particularly noteworthy in her home province of Alberta, which has come under criticism for having some of the highest dental fees in the country. One clinic in Los Algodones, in fact, appears to be targeting Albertans looking for cheaper services by marketing itself through the website albertadentalclinic.com.
Drew Barnes, the health critic for Alberta’s Wildrose party, says he regularly hears complaints from constituents about the fee issue. “They tell me that a lot of them can’t afford dentistry fees, that they go to other jurisdictions when they have to, whether it’s in Montana, Saskatchewan, Arizona or Mexico, and they feel they get quality service and substantial savings when they do that.”
There are risks, however. While Alberta Blue Cross covers out-of-country dental claims, some insurance companies may choose not to do so, says Joan Weir, director of health and dental policy at the Canadian Life and Health Insurance Association. Reimbursement, she notes, depends on the insurer and the agreement with the plan sponsor.
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As for Albertans who refrain from travelling abroad, high dental fees continue to be an issue. According to a study undertaken on behalf of Alberta Blue Cross in August 2015, 62 per cent of Albertans limit their visits to the dentist because of the high prices charged for dental care. Children are feeling the impact as well. Forty-seven per cent of those with children limit their kids’ dental visits for the same reason.
Confusion about fees
What’s more, fees vary greatly among dentists, says Sharmin Hislop, corporate communications manager at Alberta Blue Cross. “Everyone in Alberta knows dentists are all over the board. The fees can be in one neighbourhood one rate and just down the street completely different. It’s concerning for us because our plan members, they’re paying out of pocket regardless of the type of coverage we can offer them.”
Alberta Blue Cross provides two dental schedules for plan sponsors in Alberta: a usual-and-customary schedule updated annually and determined by the market in that province and another that considers what would be reasonable in Alberta in light of other provincial dental associations’ fee guides.
While many plan sponsors opt for the usual-and-customary schedule, most find it rarely covers 100 per cent of dental expenses, says Hislop, adding that Alberta is unique as the only province without a dental fee guide.
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In 1997, the Alberta Dental Association and College stopped publishing the guide, which lists dental procedures and their suggested fees. Other provincial dental associations publish a fee guide annually for dentists.
The guide is important for insurers in determining premiums and how much they’ll reimburse, according to Weir. While dentists are ultimately in control of how much they charge for their services, she says guides are useful for helping dentists bill within a reasonable fee schedule.
With no fee guide to provide a baseline, the Canadian Life and Health Insurance Association conducts its own annual review of dental costs in Alberta, says Weir. The organization analyzes aggregate claims for 80 common dental codes and shares how much costs have gone up for the year with its members. Insurers then use the percentage increases to determine their own reimbursement guides and then share the information with plan sponsors.
Some insurers are providing additional resources for plan members. Sun Life has a dental fee finder that allows consumers to enter a location and find the lowest, highest and average fees of dentists practising in that area. Alberta Blue Cross encourages plan members to ask dentists for a treatment plan that they can send to their insurer for an immediate estimate.
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In response to the backlash over discontinuing its fee guide, the Alberta Dental Association and College says there’s a public misperception around the purpose of having one. It was misuse of the guide as a schedule that led to abolishing it in the first place, says Dr. Harry Ames, membership services co-ordinator for the organization. The public “thinks that’s what [dentists] have to charge, and that’s wrong,” he says.
And when it comes to the reasons for the higher fees, dentists cite several factors:
1. Rent: Many dentists signed leaseholds before Alberta’s economic downturn, says Dr. Larry Stanleigh, a dentist with a clinic in Calgary. He cites high rents in major cities as a significant factor.
2. Staff salaries: The demand for dental hygienists and assistants far outweighs the number of qualified candidates, according to Stanleigh. Dental hygienists earn up to $60 per hour, he says, putting the average hourly rate for assistants at $30 an hour.
3. Rigorous sterilization standards: Alberta has elevated infection and prevention control standards that dentists must follow. Dr. Michael Zuk, a dentist in Red Deer, Alta., says dentists “have to do extra jumping through hoops to match the guidelines.”
Ames, however, doesn’t think all fees are higher in Alberta. “Some are higher, some are lower, depending on where you’re practising and what services you’re providing,” he says.
But for Perry Dorgan, senior vice-president and innovation lead for health and benefits at Aon Hewitt, the reasons given for the high dental fees don’t add up.
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“It’s complicated in Alberta because . . . when oil and gas was big and the economy was booming, not only do we have dental plans with very unstructured fee guides that are higher than average but we also have a whole bunch of plans that have health spending accounts,” says Dorgan.
Dentists have caught onto that additional source of revenue, Dorgan suggests.
“In my opinion, they’re charging higher amounts because they know they can get them paid in the health spending accounts,” he says.
“So, you’ve got dentists charging much higher in Alberta than any other province when you combine the two.”
Advertising wars
Adding to the confusion is the fact that dentists rarely share their fees on their websites, leaving consumers to do their own investigative work. Stanleigh says many colleagues refrain from being transparent about their costs because of the way the Alberta Dental Association and College restricts advertising.
“There are severe restrictions on what we can and cannot say,” he says. “Although they say our restrictions are the same as across Canada, it’s not quite true. We dentists don’t trust our association.”
For instance, Stanleigh says a section on his website proved to be problematic. “For the whitening section, I stated in our office, you can have professional whitening completed for as low as $250,” he says. “I was told [by the association and college] to remove that entire section, as the fee statement was unethical and a violation of the code of ethics.”
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After years of frustration, Stanleigh and two other practitioners took action in February 2016 when they launched a lawsuit on behalf of themselves and about 100 dentists against the Alberta Dental Association and College. According to the statement of claim, the plaintiffs allege the regulator’s enforcement of the advertising rules “has created a climate of intimidation and bullying.” None of the allegations have been proven in court.
Ames says he doesn’t understand the basis of the lawsuit. “As long as [dentists] are truthful and ethical in advertising, they can advertise any fees or services they want. They can’t be misleading . . ..”
Zuk, a plaintiff in the lawsuit, scaled back his radio advertisements after the association and college started investigating him for allegedly breaking some of its rules. Zuk says remaining competitive in the dental industry is “not a cakewalk,” due to advertising restrictions.
“We like to advertise, but everything we do in advertisements, they put rules and regulations out that make it difficult for us to put out limited-time specials or anything different,” he says.
Addressing the issue
Breaking up the Alberta Dental Association and College would solve many of the issues, according to Barnes. “It would do it by having one association advocate on behalf of the profession and the other on a more competitive environment and transparent marketplace for Albertans. We need to make sure dentists can advertise more openly.”
In light of the concerns, Alberta Health has been consulting stakeholders and expects to solicit public opinion by the end of the year. At that time, it will look at solutions to address the issue.
“It’s clear something needs to be done about soaring dental fees in this province,” said Alberta’s health minister, Sarah Hoffman.
Infographic: Find out how common dental fees compare across Canada
Jann Lee is an associate editor at Benefits Canada.
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Editor’s note: Story updated Nov. 17 to correct an error in the hourly rate for dental hygienists. The original version stated they earn up to $35 an hour, whereas Dr. Larry Stanleigh says the rate is now up to $60 an hour.