Just had a conversation with an insurance company regarding the amount they will reimburse for a dental claim for a crown. Last year the amount eligible was $934 but this year it is $744 (item code 27301-47). (The tooth is a separate item 23601-47 $156 (2009) and $167 (2010)).

I asked for a complete list of the sums they reimburse for all the dentistry codes but they refused saying they had no such list in a format that could be sent and that the sums were set by the Alberta Dental Association Fee Guide and I would have to contact the association to obtain the guide.

After investigating a little further it appears that Alberta is the only province where the Dental Association does not publish a fee guide and instead they provide survey information to insurance companies. According to the article below charges and reimbursement is all a big secret.

http://www.cbc.ca/canada/calgary/sto...s-alberta.html

It does appear that the dentistry market in Alberta is particularly restricted in facilitating price competition for the consumer in both purchasing the dental service and the insurance aspect.

It would be interesting to get feedback on the range of eligible costs allowed by insurance companies for the 27301-47 work item above.

Yeah, it's like a conspiracy, I know how you feel. Even if you phone around it's hard to get the information. There's a system I've seen at the dentist's that shows reimbursement amounts (called EGI I think) so getting friendly with a dentist seems the only way.

Even then I think the dentist can only get the information when they're actually submitting a claim.

I'm looking through my ABC info right now and it looks to me as though they intentionally use a name to describe the procedure to make comparison difficult.

Not really that hard to find with the help of Google.

Here's a PDF document with the rates of payment for 2010 for coverage provided by Alberta Blue Cross.

Gives you some idea as to what other insurance companies will cover.

Thanks for that sheet. It's useful background and suggests Alberta Blue Blue Cross are reasonable by publishing some coverage rates at least.

The insurance coverage I get through work sends out statements which says that the eligible amounts are " ... up to the amount listed in the provincial dental association fee guide...". For other provinces that is probably okay as such documents exist, even if it they aren't made as available as they could be ie not on the association websites but rather paper copies put in public libraries. However, for Alberta there is no Dental Association Fee Guide so the statement made by the insurance company is incorrect and misleading. If for instance I wished to compare insurance companies I could get quotations for premiums for the coverage but there would be no way of knowing the actual sums that are covered. Lower premiums could just reflect lower eligibility amounts for treatment.

It's in the interest of the dental industry and insurance industry to discourage price competition but Alberta seems to be even worse than the other provinces. It seems like different insurance companies may reimburse at different rates whereas for other provinces the reimbursement rate is fixed within the province based on the dental association fee guide. Dentists are usually reluctant to give out their prices and it seems the insurance companies can if they wish keep their reimbursement rates secret until the treatment is undertaken so the consumer is taken advantage of in both aspects.

Crown isn't on there though. Well it is, sort of. This is what I was saying.

It was

Look at that list and tell me you can say what the reimbursement price for a crown is.

Then read this: https://www.ab.bluecross.ca/individu...ies/index.html click on plan C and it says 50% up to $1,000 in the third year.

I've got the actual plan details with all the fine print and I'm damned if I can find crown in there for plan C.

It does say check plan details in that link you posted, so is it $750, or is it up to $1,000 for 50%? And there is a lengthy waiting period before you can claim it.

Vague.

To me you won't get anything on a crown until the third year. The $1000 is an overall limit for all your claims in the year ie including basic treatment. The $750 is the limit on what portion of what the dentist charges for the crown, so you get 50% of that ie if the dentist charges $1000 you only get $375 back.

On my scheme I have no complaint about any waiting period as I claimed on a crown 6 weeks after joining the scheme. It still cost me $750 over the amount that could be claimed though.

Blue Cross are being half decent by publicising eligible amounts for common items. However, the insurance companies should be made to provide the full list of eligible amounts for all the items so customers can compare like with like.

I know I won't get anything until the third year, I'm just not clear on what I will get, like you said is it $375 or is it $750. Or is it $1,000. I don't know, the fine print of the contract doesn't help at all. And it doesn't specifically say: "crown" under common procedures. There are crown-like procedures listed.