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A Dental Fact Sheet

If you are an employer concerned about the rising cost of your employee dental plan be assured you are not the only one. These are facts that making it virtually impossible for Ontario employers to control their dental benefit costs:

FACT # 1.: The Ontario Dental Association on January 1, 2002 did away with "packaged codes" that had initially been introduced into the Fee Guide a number of years prior as a means of reducing costs.
FACT # 2.: At the same time, The Ontario Dental Association eliminated codes that were age related. As a result, in most cases treatment for a child now costs the same as treatment for an adult.
FACT # 3.: There is no medical research that supports either a six month or nine month recall visit. The six month recall was simply a marketing campaign started over thirty years ago by organized dentistry that proved so financially successful for dentists that it was adopted universally. "Patient specific" recall visits should be the norm.

FACT # 4.

In the most recent fee guide, codes for periodontal appliances were moved from the Periodontal Category of Services to the Category of Preventive Services. Preventive services are usually covered under most group insurance contracts at 100% while Periodontal services are covered at a reduced rate.

FACT # 5.: Codes for occlusal adjustment/equilibration were moved from the Periodontal Category of Services to the Preventive Services Category for the same reason identified in Fact 4.
FACT # 6.: In 1999, the Ontario Dental Association hired a consultant to revamp the Fee Guide. His published mandate was to "maximize revenue for dentists". No where in the initial document was there any mention of any concern regarding the impact it may have on plan sponsors.
FACT # 7.: Electronic Data Interchange (EDI) and Assignment of Benefits were introduced as ways to reduce administrative costs and expedite the claims process. While plan members, dentists, and insurers all benefited, most plan sponsors experienced an increase in their overall dental claims loss ratio far in excess of any administrative savings they shared in.

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Barrons Financial Advisory Services Ltd. All Rights Reserved

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