B.C. dentists wary of federal dental plan before launch

The Canada Dental Care Plan is set to launch in May, but only 15 per cent of BC dentists have signed up.

The president of the British Columbia Dental Association says only 15 per cent of the province's dentists, or one in seven, are registered in the soon-to-launch National Dental Care Plan.

“The reality is you need close to 50 per cent participation for the program to be truly feasible and viable,” Rob Wolanski said of the issue of acceptance of the Canada Dental Care Plan (CDCP) among B.C. dentists. The program will Basic dental coverage is offered to anyone with a net household income of less than $70,000, with sliding discounts available to anyone with income between $70,000 and $90,000.

But Wolansky said dentists have not yet fully understood the terms and conditions of the program, so the association is advising dentists to hold off on enrolling until the federal government provides that information.

“We don't even know what all the issues are because so much of our agreement was signed in secret,” Wolansky said.

Dentists face several problems, Wolansky said.

“This plan was not developed because the government planned ahead,” Volankes said.

“This was done purely for political reasons, right, for the supply agreement? [the NDP] Contact with the Liberal Party. So that means they have to move quickly,” he asserted.

Wolansky said the government appears to have “taken the non-insured health benefit (NHIB) program off the shelf” and copied Aboriginal Dental Insurance. The problem is, in British Columbia, the First Nations Health Board canceled the NHIB program in 2019 in favor of its own, more successful model.

The problems began when provincial associations across Canada were unable to discuss the plan with their members until October due to confidentiality agreements imposed by the government on negotiations. Wolansky said those confidentiality agreements had been revoked, but the details of the government's plans were unclear and registered dentists would be bound by the rules.

One initial concern was compensation. Wolansky said dentists now know that, on average, they will be reimbursed about 86 percent of the work they do for qualifying patients. Some procedures will receive close to 100% reimbursement, while others will receive only 40% of what would be charged to patients (and their private insurance companies, if applicable) under the current fee structure.

Most dental practices have overhead costs of about 70 percent, Wolanski said, so what appears to be a small expense reduction actually amounts to a significant reduction in practice wages and investment.

Wolansky said rural dentists are likely to be hardest hit by the plan's fee structure: “If it's a small percentage, the dental office can absorb it, but if it's a large percentage, you're in trouble.”

Wolansky said dentists have implemented a number of initiatives that account for about 2 per cent of their revenue, ranging from seniors discounts to existing provincial subsidies and pro bono services for vulnerable patients.

Wolansky said he's not only worried about the fee structure eating into overhead, but also about staffing burden, which has become a key issue for offices across the province.

First, Wolansky said the association didn't know how front-end staff were supposed to monitor billing and eligibility with Sun Life, the program's administrator.

“In a regulated dental plan, the relationship is between the insurance company and the patient. This plan changes that relationship and they want to create a relationship between the insurance company and the dentist,” he said. “All risk of falls lies with the dentist.”

He said the details of how dentists would be compensated and what administrative actions they would need to take have not yet been fully fleshed out by the government.

Wolansky said another problem, at least in the short term, is the political messaging surrounding the plan. What he meant was that the public got the impression that they could get free dental treatment.

“This is not a standardized dental plan, it is a subsidized care plan. I mean the subsidized care plan has features designed to reduce costs. The minister has said 'we have to respect taxpayers' money' and we understand that. But They usually do this in two ways: lowering costs and reducing the number of procedures that are covered.

“This is not free dental care. There is going to be a cost associated with it, and for the patient, we can't even tell them what the cost is because it all depends on what happens in the future,” the Nanaimo dentist said.

One issue that could ease concerns is what the government calls an “alternative pathway,” whereby dentists can not participate in the program but still bill Sun Life directly for eligible patients.

However, even this alternative route carries risks, as it is understood dentists must agree to the program's terms and conditions, which could mean unnecessary bureaucracy, including being audited, Wolansky said.

According to the government, “Most services covered by CDCP will be available in May 2024, when the first successful CDCP applicants will begin receiving services. Some oral health services (such as dental crowns) require pre-authorization and will be available in 2024 Available starting in November.

The government says the program will cost $13 billion over the next five years and $4.4 billion each year thereafter. About nine million Canadians will be eligible for some discounts.

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