The Advantages of Dental Benefits Plans

Louis Dubé, DMD •

© J Can Dent Assoc 2001; 67:202-3

One of the main advantages of traditional dental plans is that patients have the freedom to choose their treatment and their dentist. It is to preserve this freedom of choice that CDA and its corporate members have been fighting hard to prevent the establishment of managed care. Certainly, the fact that many Canadians have dental plans is a positive development, both for the population and the profession, since it means more people have access to dental care.

I agree with Dr. Kaufmann that the current benefits limit, which has been the same for almost 20 years, is completely out of synch with today’s world. Although it is easy for insurance carriers to blame dentists for the rising cost of plans, there are other factors involved. For example, public awareness about good oral health has meant increased utilization as well as increased demand for better treatment and elective procedures. These treatments cost more.

All stakeholders involved in benefits plans have their own concerns. Carriers continue to structure plans according to their needs, and for them, managed care is an appealing way to keep costs down. Employers want to provide plans that offer the best quality-cost ratio. (Too often, an employer’s financial capacity is what limits coverage.) Employees want the best quality plans possible for themselves and their family. Dentists want plans that contain less administrative barriers and ensure freedom of practice for them and freedom of choice for their patients. It is easy to see why sometimes the pieces of the puzzle don’t all fit together.

I also agree with Dr. Kaufmann that dentists should ideally always deal with the patient regardless of the plan. CDA has never favoured assignment but recognizes that it occurs. It is important here to distinguish between assignment and co-payment, which are sometimes used interchangeably. Assignment can be a solution in certain circumstances. If a dentist collects a co-payment and respects the usual fee schedule, the patient may have a bit more flexibility in paying his or her dental costs; that process is not much different from accepting a postdated check or a credit card. On the other hand, if a dentist allows assignment but doesn’t collect the co-payment, or changes the fee or the treatment date, then he or she is committing fraud. This behaviour is unacceptable, not to mention unethical.

In my home province of Quebec, the percentage of patients who have access to dental plans is about 25-30%. The problem of having patients choose their treatment based on coverage is therefore less significant. With patients without benefits plans, the issue of insurance, assignment or co-payment doesn’t arise. Instead, our patients sometimes have to decide between paying their dental bill, buying groceries or paying the rent! The key is for dentists across the country to communicate effectively with their patients regardless of their situation. We need to start educating our patients and yes, we need the support of our provincial and national organizations. Organized dentistry has been communicating with other stakeholders including carriers, employers and employees. At CDA, that work has been accomplished mainly through the steering committee on dental benefits issues (DBI). We have achieved positive results through DBI’s work, including keeping managed care at bay.

I believe we must all work together to safeguard dental benefits plans that help patients pay the cost of their dental care without infringing on their freedom to choose their dentist or their treatment. We must take the time to talk with our patient and educate them. The days when patients would give dentists carte blanche are long gone. Dentists must be aware of their patients’ needs and financial situation and be able to present different treatment plans accordingly. In the end, good communication will help patients make the right decisions. Dentists are the best positioned to make their patients understand the advantages (and limitations) of benefits plans and the dangers of managed care. 

Dr. Dubé is chair of CDA’s steering committee on dental benefits issues.