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Who Regulates Dental Care and Billing in Canada?

The dental care industry in Canada is generally not well understood, and because dental care is not covered by provincial health insurance plans, the industry sets its own standards for professional conduct. But that doesn’t mean there are no rules for dentists and other dental healthcare providers!

When you are trying to understand the codes of conduct observed by dental care providers, it’s a good idea to start with an overview of who regulates dental care and billing in Canada.

Dental Regulatory Process in Canada

In Canada, healthcare services are mainly covered by a publicly funded system. The planning, administration and billing for these services are handled by individual provinces separately. This decentralized approach means that regulation and oversight of these services is managed at a provincial level. Healthcare professionals, including dentists, fall under the authority of the provinces.

Healthcare in Canada is governed at a federal level under the Canada Health Act (CHA). There are five core principles governed by the CHA:

  • Public Administration: Provincial health insurance must be administered publicly and on a non-profit basis. Those responsible for the administration are accountable to provincial or territorial authorities, and all records and accounts are subject to audit.
  • Comprehensiveness: The services of doctors, hospitals, surgeons and surgical dentists must be insured in each province.
  • Universality: Insured residents are all entitled to an equal level of care, regardless of where they reside in Canada.
  • Portability: An insured resident who relocates to another province may receive care in their home province during the minimum waiting period.
  • Accessibility: Insured persons should have reasonable access to healthcare facilities and services. Those providing healthcare services should receive fair compensation.

It is important to bear in mind that the CHA governs only those healthcare services that are covered by the government. This is generally limited to services provided at a hospital or by a physician. Dental care, which is not covered by the province or territory other than in exceptional cases, falls under a different set of regulations. Those dental services that are provided publicly made up only 5% of overall dental expenditures in Canada in 2014.

Dental Insurance Coverage Varies by Province

From province to province, there can be vast differences in the cost of dental services. In fact, even within the same province, the cost of doing business in one area can be higher than in another, thus affecting the cost of dental services. That’s why it’s so important to thoroughly review the details of your dental insurance plan to ensure that your coverage is adequate for dental work in your province of residence, and for all members of your family.

As mentioned previously, a small fraction of dental care is covered publicly under the CHA. This coverage is extended to past and present members of the military, families on social assistance, some seniors and persons with developmental disabilities, indigenous peoples with recognized status, federal prisoners and refugees.

For those not covered under these programs, there can be some confusion about who to contact with a problem with a dentist or with dental billing practice. While there is no federally recognized governing body for dental care, there is some recourse for those who feel there may be an issue with conduct.

Who to Contact With a Dental Complaint

To accommodate the different guidelines established in each province, there are separate dental associations that regulate and oversee conduct in the dental profession. In some cases, membership in the professional association is a requirement to maintain a license to practice dentistry in that province.

These provincial associations operate over and above the dental regulatory authority administered by the Canadian Dental Association. To help facilitate contact between patients and the provincial bodies that regulate dental conduct, the Canadian Dental Association has published a list of the Dental Regulatory Authorities and Associations across Canada. If you have questions about dental care regulation, please consult the relevant association in your province.

Let an Insurance Broker Help

Even though dental care services are not covered by government dental insurance in Canada, seeing a dentist regularly can help maintain your overall health and well-being. For those who struggle to find a way to pay out of pocket for oral health care services, an individual health and dental insurance plan can help.

When evaluating your options for a health and dental insurance policy, an insurance broker can serve as your guide to ensure that your needs, and your family’s needs, will be covered on a long-term basis. A broker can help you understand the subtle differences between policies to make sure you’re getting the best value.

When you’re ready to choose the dental insurance plan that is right for your family, we are here to help. Contact our offices today for a free, no-obligation quote for your health and dental insurance coverage needs.

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