Demystifying Dental Fees and Claims

Understanding dental charges and claims doesn’t have to be like learning a foreign language. In this article, we demystify dentist fees and dental claims – all to help you become more informed.

What is the Dental Fee Guide?

The British Columbia Dental Association (BCDA) produces an annual fee guide for BC dentists, outlining over 1,400 dental codes, code descriptors and suggested fees that relate to specific elements of dental treatment. The document serves as a guide only: dentists are not required to follow the guide or any fee schedule.

Many dental plan providers base their coverage on the fees and codes within this guide. Sun Life, the RSB Program’s Dental Plan provider, reimburses for dental services based on the current year’s BCDA fee guide for general practitioners.

How do dentists determine their fees?

The cost of delivering high-quality dental care is based on the complexity of treatment for each patient, as well as the cost of the following factors:

  • Specialized equipment
  • Approved materials
  • Sterilization and safety protocols
  • Trained and licensed professional staff
  • External laboratory fees
  • Location of dental practice

What about fees for dental specialists?

Dental specialists receive additional training in a particular field of dentistry. When a high level of expertise is required, general practice dentists will refer patients to a specialist.

Specialized treatment can involve the use of special equipment, specific materials for treatment, additional staffing and ongoing education. All these factors are considered by specialists when determining treatment costs.

How can I be more informed?

  1. Talk to your dentist. Discuss all of your treatment options and the associated costs before proceeding. (Read on to learn what you need to do for recommended dental care procedures in excess of $500.)
  2. Ask if your dental office follows the BCDA fee guide. A dental office may bill some, or all, codes based on the suggested fee guide. The RSB Program’s Dental Plan reimburses based on the current year’s BCDA fee guide for general practitioners. If your dental office charges more than the guide, you’ll be responsible for the additional cost.If you receive dental services from a dental specialist, Sun Life reimburses based on the BCDA fee guide for general practitioners, plus 10%. You’re responsible for any amounts not covered by the UBC Dental Plan.
  3. Get a preauthorization for recommended dental work prior to receiving treatment. For dental care procedure(s) in excess of $500, you must receive a preauthorization from Sun Life before you obtain treatment. To begin the process:
  • Ask your dentist to complete the Dental Claim form, detailing the dental procedure(s). Your dentist can send this form to Sun Life for you by email or regular mail.
  • Your dentist should include supporting information (e.g. x-rays or pictures of models or molds) to illustrate the services that are being recommended. If your dentist doesn’t provide this information, your preauthorization for services will be declined until this information has been received and reviewed by Sun Life. Sun Life may also request further information from your dentist as part of its review process.
  • Once the review process is complete, Sun Life will send you a Claims Statement outlining what part of the cost is covered by the plan and what you will have to pay.

How do I make a dental claim?

Many dental offices will submit claims for your dental procedure(s) directly to Sun Life. You’ll need to provide your dentist with your UBC Group Number (020605) and your Member ID (seven-digit UBC employee number).

If your dentist does not submit claims on your behalf, you can submit a claim yourself using the Dental Claim form.