Accepting government-sponsored dental plans

April 27, 2017

Some Public Health Units in Ontario have identified concerns around “additional fees” charged to some participants in provincial government-sponsored dental programs.

Dentists who accept government-sponsored dental plans are contributing a valuable service to the community. They are providing access to oral health care services to those who might not otherwise be able to afford them.

In accepting these provincial plans, dentists are agreeing to accept fees that are often lower than their usual and customary fees. Participation in these plans requires that dentists bill accurately and not impose additional fees that may not be appropriate. Examples of “additional fees” include administrative fees levied on patients in order to access dental care as well as charging in excess for services covered under the government plan.

The RCDSO reminds dentists that if they elect to participate in provincial government-sponsored programs that they are agreeing to accept the terms and conditions under the plan. This includes fees established by the program, submitting claims and arranging for the co-ordination of benefits for patients who have additional insurance coverage.

Dentists may charge patients for services not covered by a government-sponsored plan, but must inform them of the fees they would be responsible for prior to initiating treatment.

In addition, dentists should not charge additional fees (such as booking fees) for patients on social services or other government funded dental programs unless they are charging this for all patients who are attending the office for similar treatment.

If additional fees are charged, they should be refundable upon attendance and/or applied to services completed. Patients that are receiving social assistance should also be given equal access to the dental office (same hours) as private pay patients.

For more information, contact the College's Practice Advisory Service at 416-934-5614, toll free at 1-800-565-4591, or by e-mail at practiceadvisory@rcdso.org.