abcds member handbook

Dental Schedule Handbook

Your guide to the Alb erta B lue Cross Dental Schedule 2015

Alberta Blue Cross Dental Schedule: Helping you keep your healthy smile

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1

This handbook provides an informative reference guide for the Alberta Blue Cross Dental Schedule including a list of the maximum amounts your plan will allow for the most common dental procedures.

Please refer to this schedule prior to your dental appointments.

Important note Coverage for specific dental procedures varies depending upon your particular plan design.

Some procedures listed in this book may not be covered by your particular dental plan. Please consult your plan contract or benefit booklet for more information.

About the schedule

2

In Alberta, individual dental providers are able to set their own prices. This situation differs from that in many other provinces where dentists follow a fee guide established by provincial dental associations. As a result, dental offices across Alberta charge widely varying prices for dental services. In some cases, consumers are able to negotiate lower prices for dental services. In other cases, a portion of each dental visit may not be covered regardless of the level of coverage provided through the dental plan.

The Alberta Blue Cross Dental Schedule provides our plan members with a consistent and reasonable basis for payment of dental claims. The amounts are established by analyzing other provincial dental associations' fee guides, economic factors and what is deemed reasonable in the current market.

Dental benefits for more than 380,000 Albertans are paid according to the Alberta Blue Cross Dental Schedule.

Why a dental schedule?

3

This handbook lists the maximum amounts your plan allows for many common dental services. Your eligibility for coverage of specific procedures depends on your particular plan design. Some procedures listed in this book may not be covered by your particular plan.

All Alberta dental offices have access to the 2015 Alberta Blue Cross Dental Schedule. Your dental provider also has quick and easy access to information about your dental coverage electronically through CDAnet and DACnet.

The Dental Schedule Handbook

Today, more than 380,000 Albertans have dental benefits paid according to the Dental Schedule.

4

Understanding your dental scheduleKeeping your plan affordableThe Alberta Blue Cross Dental Schedule exists to provide you quality dental benefits while keeping your plan viable and affordable. Each year, payment amounts are established that are reasonable and in most cases are equal to or higher than other western provinces. The dental schedule allows you to have dental coverage through a viable, economical benefit plan.

It’s important to understand that your plan pays dental expenses according to the Alberta Blue Cross Dental Schedule. This means that if your plan states you have 100 per cent dental coverage, your plan will pay 100 per cent of dental schedule amounts, not necessarily 100 per cent of what the dentist charges.

5

As fees for dental services in Alberta are set by each dentist, and in many cases are rising at levels beyond inflation, if Alberta Blue Cross were to simply pay what each individual dentist billed, your dental plan rates would have to be increased substantially. Over time, this would make your benefit plan unaffordable.

6

Make the most of your dental scheduleBe sure to notify your dental office that your dental coverage is paid according to the Alberta Blue Cross Dental Schedule, and verify whether you will be charged for dental services according to these amounts. If your dental provider charges more than what your dental plan allows, you may face out-of-pocket costs.

To make it easier to have a discussion about the amount charged for dental services, please show your Alberta Blue Cross ID card to ensure your dental office has your correct coverage information. You may also cut out the quick reference card on the back cover of this handbook and present it at your dental appointment.

7

Should your dental provider bill more than your dental schedule, you will be responsible for paying the difference. You do have the following options: • You can negotiate a better price for dental services. • You can agree to pay any extra amount billed

beyond what the Alberta Blue Cross Dental Schedule pays.

• You can access services from another dental provider.

You will still be required to pay any applicable co-pay or deductible amounts (where applicable) at the time of your appointment.

Decisions about treatment remain between you and your dental provider.

8

Enjoy the advantages of direct billingAlberta Blue Cross plan members and dental providers benefit from the convenience of direct “assignment” billing.

When your dental provider bills Alberta Blue Cross directly for services covered by your plan, you don’t have to pay the entire cost up front. You will still be responsible for payment of any co-pay or deductible amounts. This also helps your dental provider reduce administration costs and receive payment promptly.

Today, most general practitioner dentists and denturists bill Alberta Blue Cross directly for patients’ dental claims.

… you don’t have to pay the entire cost up front, and your dental provider receives payment promptly.

9

Dental providers make the choice whether to bill Alberta Blue Cross directly or not.

Before your next dental appointment, confirm that your dental office accepts assignment billing and uses online claims submission.

10

Comparing pricesOn the pages that follow are

costs for some common dental procedures. There’s also a

comparison with other western provinces that shows the Alberta

Blue Cross Dental Schedule amounts are comparable to

the 2014 provincial dental associations’ General Practitioners

fee guides in British Columbia, Saskatchewan and Manitoba,

for similar procedures.

11

Your dentist can quickly check how much your plan pays for dental procedures and how much, if anything, you will have to pay by submitting a predetermination to Alberta Blue Cross prior to your appointment. Be sure to ask your dentist about this convenient service.

Coverage for specific dental procedures varies depending on your particular plan design. Please consult your plan contract or benefit booklet for more information. Or, learn more about your benefit details by signing into our member services web site by going to www.ab.bluecross.ca and clicking "Sign in".

The 2015 Alberta Blue Cross Dental Schedule offers plan members good value through a benefit plan that contains viable, affordable dental coverage.

12

Offering valueThe Alberta Blue Cross Dental Schedule takes into account the costs associated with operating a dental practice and is a well-researched and credible basis for payment of your dental claims.

The dental schedule is reviewed on an annual basis to ensure it continues to meet the needs of all concerned. This review considers a wide variety of economic factors, as well as feedback from both dental providers and our customers.

Each year, the dental schedule fee amounts are increased to appropriately reflect the economy, dental expenses and other factors, while still ensuring reasonable benefit plan rates.

13

Alberta Blue Cross Dental Schedule Comparison to the 2014

Provincial Dental Associations’ General Practitioner Fee Guides in Manitoba, Saskatchewan and

British Columbia

Alberta Blue Cross

Dental Schedule

British Columbia

Saskatchewan Manitoba

Recall exam Procedure 01202

$51.30 $27.20 $32.00 $30.70

2 Bitewing RadiographsProcedure 02142

$28.70 $23.20 $29.00 $25.50

2 Time Units ScalingProcedure 11112

$103.60 $64.40 $72.00 $92.40

1 Time Unit PolishingProcedure 11101

$43.20 $33.90** $33.00** $36.00

Fluoride Procedure 12101

$19.30 $13.80 $21.00 $17.80

Total $246.10 $162.50 $187.00 $202.40

*no longer based on units of time.

Typical annual checkup for adults

14

Alberta Blue Cross Dental Schedule comparison to the 2014

provincial dental associations’ general practitioner fee guides

in Manitoba, Saskatchewan and British Columbia

Alberta Blue Cross

Dental Schedule

British Columbia


Recall exam Procedure 01202

$51.30 $27.20 $32.00 $30.70

2 Bitewing RadiographsProcedure 02142

$28.70 $23.20 $29.00 $25.50

1 Time Unit ScalingProcedure 11111

$51.80 $32.20 $36.00 $46.20

1 Time Unit PolishingProcedure 11101

$43.20 $33.90** $33.00** $36.00

Fluoride Procedure 12101

$19.30 $13.80 $21.00 $17.80

Total $194.30 $130.30 $151.00 $156.20

*no longer based on units of time.

Typical annual checkup for children

15




Alberta Blue Cross

Dental Schedule

British Columbia


4 surface amalgam (silver) filling—

permanent molar Procedure 21224

$216.00 $227.00 $206.00 $203.10

2 pins for fillingProcedure 21402

$43.00 $44.00 $59.00 $34.50

Total $259.00 $271.00 $265.00 $237.60

Restorations (fillings)Each person has unique dental needs, so your dental treatment may be different from the examples shown here. Please note that some procedures listed in this book may not be covered by your particular dental plan.

16

Crown procedures

Root canal therapy




Alberta Blue Cross

Dental Schedule

British Columbia


Porcelain fused to metal crown

Procedure 27211$766.30* $711.00* $711.00* $682.90*

Post—cast metalProcedure 25721

$165.60* $120.00* $182.00* $163.90*

Total $931.90 $831.00 $893.00 $846.80*Plus lab fees.




Alberta Blue Cross

Dental Schedule

British Columbia


Three root, root canal therapy

Procedure 33131$798.80 $782.00 $827.00 $761.70

(Dentist's fees only: all fees have additional lab charges).

17

Coverage for specific dental procedures varies depending upon your particular plan design.

Some procedures listed in this book may not be covered by your particular dental plan.

Please consult your plan contract or benefit booklet for more information.

Three unit bridg‘e proceduresAlberta Blue Cross Dental

Schedule comparison to the 2014 provincial dental associations’ general practitioner fee guides


Alberta Blue Cross

Dental Schedule

British Columbia


Retainer, (crown) for fixed bridge * Procedure 67211

$728.80* $692.00* $664.00* $695.50*

Retainer, (crown) for fixed bridge *Procedure 67211

$728.80* $692.00* $664.00* $695.50*

Pontic, for fixed bridge (to replace missing

tooth)Procedure 62501

$326.30* $318.00* $316.00* $335.60*

Total $1,783.90 $1,702.00 $1,644.00 $1,726.60*Plus lab fees.

(Dentist's fees only: all fees have additional lab charges).

18

Regardless of your age, dentures are a viable option to replace missing teeth.

Denturists are independent dental professionals who examine, diagnose and treat patients who require dentures. They usually offer their services from denture clinics, which function independently of dentists. In Alberta, denturists have expanded duties and provide complete or partial denture services.

Denture services

19

Examples of denturist fees

Not all procedures listed in this book may be covered by your plan.

Consult your plan contract or benefit booklet for more information.

Procedures Professional fee

General prosthodontic exam Procedure 01701-10010

$65.20

Complete upper dentureProcedure 51101-31310

$646.80*

Complete lower dentureProcedure 51102-31320

$646.80*

Partial upper dentureProcedure 53101-41114

$688.80*

Complete upper denture repairProcedure 55101-36110

$58.80*

Complete upper denture reline (processed)Procedure 56231-32215

$194.90*

*Plus lab fees.

20

Examples of common dental proceduresCompared to 2014 British Columbia, Saskatchewan and Manitoba Dental Association Fee Guides for General Practitioners.

** no longer based on units of time

Offering value

Procedure code DescriptionAlberta Blue Cross

Dental ScheduleBritish

ColumbiaSaskatchewan Manitoba

01103 Complete examination (new patient—all permanent teeth) $106.90 $90.60 $101.00 $95.5001201 Limited new patient examination $51.30 $41.10 $41.00 $37.5001202 Recall Examination (checkup) $51.30 $27.20 $32.00 $30.7001204 Specific examination $51.30 $34.90 $40.00 $43.0001205 Emergency examination $51.30 $51.00 $48.00 $37.5002102 Full set of X-rays $108.70 $93.00 $140.00 $100.7002111 One X-ray (periapical) $19.80 $17.00 $22.00 $18.5002112 Two X-rays (periapical) $28.70 $23.20 $29.00 $25.5002113 Three X-rays (periapical) $37.60 $29.60 $37.00 $32.5002114 Four X-rays (periapical) $46.50 $36.00 $45.00 $39.5002142 Two X-rays (bitewing) $28.70 $23.20 $29.00 $25.5002144 Four X-rays (bitewing) $46.50 $36.00 $45.00 $39.5002601 Panoramic (whole mouth) X-ray $73.20 $64.40 $67.00 $67.4011101 Polishing (up to 15 minutes) $43.20 $33.90** $33.00** $36.00

21

Coverage for specific dental procedures varies depending upon your particular plan design. Some procedures listed in this book may not be covered by your particular dental plan.

Please consult your plan contract or benefit booklet for more information.

Offering value




01103 Complete examination (new patient—all permanent teeth) $106.90 $90.60 $101.00 $95.5001201 Limited new patient examination $51.30 $41.10 $41.00 $37.5001202 Recall Examination (checkup) $51.30 $27.20 $32.00 $30.7001204 Specific examination $51.30 $34.90 $40.00 $43.0001205 Emergency examination $51.30 $51.00 $48.00 $37.5002102 Full set of X-rays $108.70 $93.00 $140.00 $100.7002111 One X-ray (periapical) $19.80 $17.00 $22.00 $18.5002112 Two X-rays (periapical) $28.70 $23.20 $29.00 $25.5002113 Three X-rays (periapical) $37.60 $29.60 $37.00 $32.5002114 Four X-rays (periapical) $46.50 $36.00 $45.00 $39.5002142 Two X-rays (bitewing) $28.70 $23.20 $29.00 $25.5002144 Four X-rays (bitewing) $46.50 $36.00 $45.00 $39.5002601 Panoramic (whole mouth) X-ray $73.20 $64.40 $67.00 $67.4011101 Polishing (up to 15 minutes) $43.20 $33.90** $33.00** $36.00

22

Examples of common dental procedures (continued)Procedure code Description

Alberta Blue CrossDental Schedule

BritishColumbia


11111 Scaling (removal of tartar, up to 15 minutes) $51.80 $32.20 $36.00 $46.2011112 Scaling (removal of tartar, up to 30 minutes) $103.60 $64.40 $72.00 $92.4011114 Scaling (removal of tartar, up to 60 minutes) $207.20 $128.80 $144.00 $184.8012101 Fluoride $19.30 $13.80 $21.00 $17.8013401 Pit and fissure sealant (first tooth) $29.20 $26.10 $27.00 $28.00

13409 Pit and fissure sealant

(each additional tooth same area)$14.60 $14.40 $18.00 $14.00

21112 Two surface amalgam (silver) filling

—primary tooth $116.40 $110.00 $109.00 $105.20

21113 Three surface amalgam (silver) filling

—primary tooth $134.40 $119.00 $125.00 $116.60


—permanent anterior tooth/bicuspid $131.20 $125.00 $142.00 $116.00




—permanent molar $154.20 $151.00 $159.00 $135.60

21224 Four surface amalgam (silver) filling

—permanent molar $216.00 $227.00 $206.00 $203.10

21401 One pin for filling $31.00 $29.10 $38.00 $22.90

23




11111 Scaling (removal of tartar, up to 15 minutes) $51.80 $32.20 $36.00 $46.2011112 Scaling (removal of tartar, up to 30 minutes) $103.60 $64.40 $72.00 $92.4011114 Scaling (removal of tartar, up to 60 minutes) $207.20 $128.80 $144.00 $184.8012101 Fluoride $19.30 $13.80 $21.00 $17.8013401 Pit and fissure sealant (first tooth) $29.20 $26.10 $27.00 $28.00

13409 Pit and fissure sealant

(each additional tooth same area)$14.60 $14.40 $18.00 $14.00


—primary tooth $116.40 $110.00 $109.00 $105.20


—primary tooth $134.40 $119.00 $125.00 $116.60






—permanent molar $154.20 $151.00 $159.00 $135.60

21224 Four surface amalgam (silver) filling

—permanent molar $216.00 $227.00 $206.00 $203.10

21401 One pin for filling $31.00 $29.10 $38.00 $22.90

24

Examples of common dental procedures (continued)Procedure code Description

Alberta Blue CrossDental Schedule

BritishColumbia


21402 Two pins for filling $43.00 $44.00 $59.00 $34.5022211 Stainless steel crown - primary tooth $200.80 $186.00 $176.00 $166.40

23111 One surface composite (white) filling

—permanent anterior tooth $125.50 $116.00 $122.00 $115.30

23113 Three surface composite (white) filling


23312 Two surface composite (white) filling

—permanent bicuspid$197.10 $185.00 $191.00 $182.40


—permanent molar$151.20 $145.00 $153.00 $137.20


—permanent molar$266.40 $269.00 $244.00 $238.30

23512 Two surface etched composite

(white) filling—primary posterior tooth$167.50 $174.00 $191.00 $158.90

27211 Porcelain fused to metal crown $766.30* $711.00* $711.00* $682.90*27301 Metal (gold) crown $766.30* $676.00* $711.00* $682.90*27602 Lab processed veneer $557.80* $711.00* $559.00* $513.10*

29101 Recementation of a crown

(up to 15 minutes)$73.20* $68.70* $108.00* $70.60*

33111 Root canal therapy (one root) $482.40 $425.00 $469.00 $417.10

25




21402 Two pins for filling $43.00 $44.00 $59.00 $34.5022211 Stainless steel crown - primary tooth $200.80 $186.00 $176.00 $166.40





23312 Two surface composite (white) filling

—permanent bicuspid$197.10 $185.00 $191.00 $182.40


—permanent molar$151.20 $145.00 $153.00 $137.20


—permanent molar$266.40 $269.00 $244.00 $238.30

23512 Two surface etched composite

(white) filling—primary posterior tooth$167.50 $174.00 $191.00 $158.90

27211 Porcelain fused to metal crown $766.30* $711.00* $711.00* $682.90*27301 Metal (gold) crown $766.30* $676.00* $711.00* $682.90*27602 Lab processed veneer $557.80* $711.00* $559.00* $513.10*

29101 Recementation of a crown

(up to 15 minutes)$73.20* $68.70* $108.00* $70.60*

33111 Root canal therapy (one root) $482.40 $425.00 $469.00 $417.10

26




33131 Root canal therapy (three roots) $798.80 $782.00 $827.00 $761.70

43421 Root planing

(removal of tartar, etc. from roots; up to 15 minutes) $51.80 $32.20 $36.00 $46.20

43422 Root planing


51101 Complete upper denture $715.60* $738.00* $904.00* $703.30*62501 Pontic for fixed bridge (to replace missing tooth) $326.30* $318.00* $316.00* $335.60*67211 Retainer (crown) for fixed bridge $728.80* $692.00* $664.00* $695.50*71101 Uncomplicated tooth removal (first tooth) $126.10 $113.00 $127.00 $112.00

71109 Uncomplicated tooth removal

(each additional tooth in same area) $75.70 $74.60 $84.00 $84.00

72111 Surgical tooth removal

(first tooth—soft tissue coverage) $213.80 $225.00 $218.00 $211.40

72221 Tooth removal—complete bone coverage $370.00 $370.00 $408.00 $381.80Not all procedures may be covered by your plan. Consult your plan contract or benefit booklet for more information.*Plus lab fees.

Examples of common dental procedures (continued)

27




33131 Root canal therapy (three roots) $798.80 $782.00 $827.00 $761.70

43421 Root planing


43422 Root planing


51101 Complete upper denture $715.60* $738.00* $904.00* $703.30*62501 Pontic for fixed bridge (to replace missing tooth) $326.30* $318.00* $316.00* $335.60*67211 Retainer (crown) for fixed bridge $728.80* $692.00* $664.00* $695.50*71101 Uncomplicated tooth removal (first tooth) $126.10 $113.00 $127.00 $112.00

71109 Uncomplicated tooth removal

(each additional tooth in same area) $75.70 $74.60 $84.00 $84.00

72111 Surgical tooth removal

(first tooth—soft tissue coverage) $213.80 $225.00 $218.00 $211.40

72221 Tooth removal—complete bone coverage $370.00 $370.00 $408.00 $381.80Not all procedures may be covered by your plan. Consult your plan contract or benefit booklet for more information.*Plus lab fees.

Record of AppointmentsDate:

Patient:

Name of dentist:

Service performed:

Date:

Patient:

Name of dentist:

Service performed:

Date:

Patient:

Name of dentist:

Service performed:

Date:

Patient:

Name of dentist:

Service performed:

® The Blue Cross symbol and name are registered marks of the Canadian Association of Blue Cross Plans, an association of independent Blue Cross plans. Licensed to ABC Benefits Corporation for use in operating the Alberta Blue Cross Plan. ABC 83323 2014/12

To minimize the environmental impact, we have produced this handbook on paper made with post-consumer waste fibre. Please recycle this handbook when you are done with it.

780-498-8000 Edmonton and area

403-234-9666 Calgary and area

780-532-3505 Grande Prairie

403-328-1785 Lethbridge

403-529-5553 Medicine Hat

403-343-7009 Red Deer

This dental plan pays according to amounts listed in the Alberta Blue Cross Dental Schedule.

For more information regarding Alberta Blue Cross Dental Schedule amounts and eligible benefits, please check this patient’s plan details through CDAnet™ or contact Alberta Blue Cross Dental Services.

Please present this card to your dental office prior to your appointment.

1-800-661-6995 toll free www.ab.bluecross.ca

Call usfor more information about the Alberta Blue Cross Dental Schedule

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