A bite out of low income

Some dental practices still don’t bill public program directly

Published on January 3, 2016
Submitted photo
Barbara Hollett (left), president of the Newfoundland and Labrador Dental Hygienists Association, and Nicole Kielly, president-elect of the NLDHA.

By Cory Collins
Special to The Telegram

The Adult Dental Program, launched as part of the Progressive Conservatives’ Poverty Reduction Strategy, was lauded as a meaningful expansion of coverage. But the program, meant to provide basic services to those with low income, is inaccessible for many—and not simply because of per-person caps meant to control costs.

When first introduced, the government said “(c)lients who choose a provider who has not yet been registered under the Dental Health Plan may have to pay upfront for their eligible services and will then be reimbursed.”

In reality, some clients are likely to have no choice at all but to pay up front—something the program’s target population can ill-afford. Many dental practices in the St. John’s area and in other parts of the province do not bill the program directly. A few do not accept patients using it. In some communities, such as Buchans and Burin, the only dentists listed do not directly bill part or all of the program, meaning clients have to pay up front and wait weeks to be reimbursed.

Early last week, The Telegram contacted 95 general dental practices associated with listings from the Newfoundland and Labrador Dental Association. Thirty confirmed they bill the program directly, while 26 said that they do not. Thirty-three could not be reached, were closed for the holidays or had outdated contact information. But even if all of the non-response group bills the program directly, those that make low-income patients pay up front stands at 27 per cent of practices in the province.

Social assistance recipient Tiff Lisieki of Labrador City said paying up front and waiting for reimbursement hurts those on those on a fixed income.

“It’s impossible to (afford)”, she said. “The teeth I had removed wouldn’t have had to been removed if I could have afforded fillings. It was just worth removing the tooth to get rid of the pain.”

Lieseki was also incorrectly told that, because she was on social assistance, the program does not cover her fillings. In fact, fillings are part of basic services that can be covered by the Adult Dental Program.

“The receptionist who does the billing asked if I had insurance. I said I was on social assistance, and she told me they don’t cover fillings. She didn’t mention anything about reimbursement or anything like that”, Lisieki said.

Dental association skeptical

Then-health minister Susan Sullivan had stated the government was working on “a solution that will hopefully see all providers participating in and billing the plan directly in the near future.” The details of that solution do not appear to be known. New Health Minister John Haggie was not available for an interview by publication time.

Anthony Patey, executive director of the Newfoundland and Labrador Dental Association rejected the idea that many dentists were not participating in direct billing.

“I don’t know if that’s the case. I don’t know if that’s the case at all. There might be some dentists, a short list, who are not billing the program at all.”

However, among dental practices that responded to The Telegram, nearly half did not directly bill the program. If all of those who did not respond actually do direct billing, the number that confirmed otherwise still make up one in four practices providewide.

Longer term savings a possibility

Patey said the program’s existence may save costs over the long-term, explaining how initial costs of the children’s dental program went down over time.

“That is what happens. The moment you start providing care, your need goes down. It’s a crazy business, dentistry. The more you do, the less you have to do. ...And later in life you don’t have bombed-out mouths and things of that nature.”

The Newfoundland and Labrador Dental Hygienists’ Association (NLDHA) highlighted how the program’s long term costs may be increased by not covering cleanings.

“Most provinces and territories now offer some support for preventative services (beyond) their provincial children’s dental health programs”, said Nicole Kielly, president-elect of the NLDHA.

“Some will argue that extending preventative dental care to low-income adults will cost the province too much money. (But) shifting the focus from emergency-based treatment to prevention would have a profound impact on the health of our province and would save money long term”, she added.

Patey said he “(didn’t) know what to expect” for the program’s future,  but he emphasized he understands government’s fiscal situation and has faith in its good intent.

“They’ve got a little overdraft they’ve got to deal with here and they’re going to deal with it, I’m sure, in the best possible way.”

The per-person cap on services, initially introduced as $150 has since risen to $300. A representative of the Department of Health and Community Services was not able to respond in time to a question about whether the program will remain.

But even if the cap remains untouched, it may not help people like Lisieki, who have trouble using the services to which they are entitled.

“When the only income you have is social assistance it’s pretty much impossible to afford anything at all. When I was living solely on it I could hardly afford groceries, couldn’t afford bills, transportation, or anything else at all. Let alone dental work.”

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Weblink: http://www.health.gov.nl.ca/health/dentalservices/general_info.html#0