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There, in black and white
NB Bulletin Vol. 6, N. 9, November 2007
This bulletin is addressed to groups who have access to dental care coverage and a direct claims submission system by virtue of their group insurance contract.
For almost twenty years, the Association des chirurgiens dentistes du Québec (ACDQ) has been offering the Dentaide direct payment service for dental care expenses to dentists, insurers, and insurees. This service allows insurees to pay only the uninsured portion of the fees when they visit the dentist.
Over the last few years, most of the insurers who use this service (Desjardins Financial Security, Industrial Alliance, La Capitale, and SSQ) have requested that certain changes be made to the Dentaide service in order to modernize it and to meet new needs. Several rounds of negotiations were held between these insurers and the ACDQ in order to work out a solution that would satisfy all the parties concerned. As a result of these meetings, the insurers came to the conclusion that a new system must be developed. They then gave ESI Canada (ESI) a mandate to design this new system.
This decision gave rise to a business dispute between the ACDQ (the sole owner of Dentaide) and the main insurers who use the service, which resulted in early termination of the Dentaide service. In light of this unexpected turn of events, the timetable for transferring insurees to the ESI system did not envision an interruption of service.
The table below shows the new schedule for each of the insurers involved:
Starting on the dates listed above, insurees will no longer have access to the Dentaide service, and must submit claims for reimbursement using the dentist’s claims form or the form provided by the insurer. The result of this situation is that insurees will have to pay the full cost, and wait to be reimbursed for the expenses that are covered by the group insurance contract. In order to speed up the reimbursement process during this period, SSQ is offering insurees the option of submitting claims forms by fax or by e-mail (by attaching a digitized copy of the form completed by the dentist).
Once the ESI reimbursement system is in place, it is possible that some dentists will refuse to accept the new payment card. Although the system will be operational, it will not necessarily be available through all dentists, because the Dentaide service transmits claims information by telephone, while the ESI system transmits the information electronically. Therefore, not all dentists who offer the Dentaide service have the necessary technology required to offer the ESI service to their clients. At the present time, half of Quebec’s dentists have the software needed to submit claims electronically, whereas most dentists offer the Dentaide service. In addition, as a pressure tactic directed at insurers, the ACDQ has recommended to its members (the dentists) that they refuse to use the ESI card.
In order to alleviate the inconveniences resulting from this dispute, we suggest several approaches that you can pass on to your employees in order to assist them the next time they go to the dentist:
In the case of the other insurers, Blue Cross will continue to use the Dentaide service, while Canada Life, Great-West, Maritime Life, Manulife Financial, Standard Life, and Sun Life use the service provided by BCE Emergis. Industrial Alliance has concluded a service agreement with BCE Emergis and Dentaide. The service provided by BCE Emergis is equivalent to the service offered by ESI. Because BCE Emergis is not involved in the dispute, insurees who use this system should not experience any problems with respect to claims. However, the ACDQ sent a message to its members that stated erroneously that the only card they should accept is Dentaide. This situation should be rectified during the next few weeks.
In order to facilitate the changeover and avoid any confusion, it is important to notify your employees of this situation without delay. The insurers involved in this dispute have already taken action to transmit the information to their respective insurees. Nevertheless, we recommend that you send your employees a message that outlines the situation in detail, along with the implications, and most importantly, the possibility that the dispute will persist beyond the implementation dates.
Please feel free to contact us for additional information.
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