Does Insurance Cover Emergency Dental Care in Alberta?

The quick version

• Most dental plans in Alberta cover an emergency examination and the treatment that follows.

• Coverage is usually a percentage rather than the full amount, and annual maximums apply.

• CDCP covers emergency care for eligible patients, subject to co payment.

• Call the clinic before you arrive so coverage can be checked while you are on your way.

Most dental plans in Alberta do cover emergency dental care, including the examination that diagnoses the problem and much of the treatment that follows. What varies is how much. Coverage is normally a percentage rather than the whole amount, annual maximums still apply, and the category the treatment falls into changes the reimbursement. This article explains how to find out where you stand quickly, because the middle of a dental emergency is a poor time to be reading plan documents.

What an emergency appointment usually includes

An emergency visit is built around finding out what is wrong and stopping it getting worse. It normally begins with a focused examination of the problem area and an x ray, since a great deal of what causes dental pain is not visible from the outside.

From there the treatment depends on the diagnosis. It might be draining an infection, starting root canal treatment, placing a temporary restoration, recementing a crown, or removing a tooth that cannot be saved. Each of those sits in a different category on a dental plan, which is why a single answer about coverage is impossible before anyone has looked.

How most Alberta plans treat emergencies

Workplace and private plans vary, but the shape is fairly consistent. Diagnostic services such as the emergency exam and x rays are usually covered at a higher percentage. Basic restorative treatment, including fillings and many extractions, is generally covered at a good rate. Major services such as crowns and some surgical procedures are typically covered at a lower percentage.

Two limits sit on top of all of that. The annual maximum is the total the plan will pay in a benefit year, and if you have used most of it already, an emergency in November lands differently than the same emergency in February. Some plans also apply frequency limits to particular services.

If you are covered by CDCP

The Canadian Dental Care Plan covers emergency care for eligible patients, including examinations, x rays, and a range of treatment such as fillings and extractions. Depending on household income there may be a co payment, and the plan reimburses according to its own fee structure.

TLC Family Dental Centre is accepting patients covered by CDCP and offers direct billing, which in an emergency means one less thing to arrange while you are dealing with pain.

If you have no coverage at all

Plenty of people in Leduc and the surrounding area have no dental plan, and an unexpected dental problem is genuinely stressful in that situation. It is still worth calling rather than waiting.

A dental infection does not resolve on its own, and the treatment needed tends to escalate the longer it is left. A tooth that could have been saved with root canal treatment in week one can become an extraction by week three. Say plainly on the phone that you do not have coverage, because the conversation about what is urgent now and what can be planned later is a normal one to have.

What to do before you arrive

A few minutes of preparation makes the appointment considerably more efficient.

• Call ahead rather than simply arriving, so the office can make room and check your coverage while you travel.

• Have your plan details or CDCP member number ready.

• Note when the problem started, what makes it worse, and whether there is any swelling.

• Bring a list of your current medications, including anything for blood pressure or blood thinning.

• If a tooth has been knocked out, bring it in milk or saliva rather than water, and do not scrub it.

When it is not a dental office you need

Most dental emergencies belong at a dental clinic, but a few belong at a hospital. Swelling that is closing your eye or spreading into your neck, difficulty breathing or swallowing, or a suspected broken jaw all need emergency medical care immediately rather than a dental appointment.

Uncontrolled bleeding after an injury is the same. If you are unsure, err toward the hospital. A dental problem can be dealt with afterwards, and a spreading infection near the airway is not something to wait on.

Why the exam comes before the estimate

It is a fair question why a clinic cannot quote an emergency over the phone. The reason is that the same symptom has several possible causes, and they are treated very differently.

A tooth that aches with cold might need a filling, or it might need root canal treatment, or it might be a cracked cusp that needs a crown. Those sit in different categories on every dental plan and involve very different amounts of work. An x ray and an examination are what separate them, and only then can a written estimate be accurate enough to be worth giving you.

Common questions

Will my plan cover the emergency exam?

Most plans cover diagnostic services such as an emergency examination and x rays at a relatively high percentage. The treatment that follows is covered according to its own category, which is why the total depends on the diagnosis.

Does CDCP cover emergency dental treatment?

Yes, for eligible patients, including examinations, x rays, and a range of treatment. A co payment may apply depending on household income, and the plan reimburses to its own fee structure.

What if I have already used my annual maximum?

Tell the office when you call. Treatment can often be sequenced so that the urgent problem is dealt with now and planned work is scheduled into the next benefit year.

Is it cheaper to wait and see if the pain goes away?

Usually the opposite. Dental pain from infection does not resolve on its own, and the treatment required tends to become more involved with delay. Waiting frequently converts a savable tooth into an extraction.

Can I go straight to a hospital instead?

For facial swelling that is spreading, difficulty breathing or swallowing, a suspected broken jaw, or uncontrolled bleeding, yes, go to emergency medical care immediately. For most other dental problems a dental clinic is the right place.

If you are dealing with a dental emergency in Leduc, call TLC Family Dental Centre at 780.980.5115 and we will make room for you as quickly as we can. Dr. Kyle Lesko will diagnose the problem, explain your options clearly, and provide a written estimate once the exam tells us what is actually going on.