Possible changes to dental processes in Quebec

The life and health insurance industry has been engaged in discussions with the Association des chirurgiens dentistes du Québec (ACDQ) for many months now. The key areas have addressed how insurers and dentists should work together from an administrative perspective, with a particular focus on what electronic systems insurers should use to pay dentists for their services.

As we work through these discussions, you should be aware that there could be affects to our plan members more immediately. Dentists have a choice of whether to accept assignment of benefits or not. This is not new. The ACDQ is not supportive of assignment of benefits unless the insurer and dentist are subscribed to the Dentaide program - a subsidiary of the ACDQ that offers paid payment and intermediary services for registered insurers and dentists. However, not all carriers currently participate in the Dentaide program. Our current assignment rates remain stable in Quebec, but we want you to know the possible affects to our members should dentists begin to adopt the ACDQ’s recommendations.

How this affects plan members

If a plan member’s dentist decides not to offer them assignment, it means the member will be required to pay the full amount of any dental bill out of pocket then seek reimbursement through their benefits provider. If a dentist is unwilling to submit their claims electronically, plan members will need to submit dental claims online or by paper form; submitting claims online is the fastest way for members to be reimbursed if the group plan allows this.

We’ll make every effort to process members’ claims efficiently to reduce any inconvenience.

We know that many Quebec plan members benefit from the convenience of the assignment of benefits option, and we remain willing and able to pay dentists on behalf of patients in such a way that patients only have to cover their portion of any dental bill.

Communicating with your employees

We’ve created a plan member communication. Please share this to notify your plan members of these possible changes.

We’ve prepared the call centre with some questions and answers to use if members call.

The life and health insurance industry remains committed to working with dentists in Quebec to reach a mutually-beneficial agreement for the future. Insurers and dentists have worked well together for many years and the current system generally works to everyone’s benefit. Working with the Canadian Life and Health Insurance Association and other insurers, we remain committed to having a productive dialogue with dentists in Quebec. The life and health insurance industry continues to put a priority on ensuring patients can access the care they need. We will keep you informed as developments continue.