Alberta is the only province without a dental fee guide, which gives patients an advantage through better competition, says Dr. Randall Croutze of the Alberta Dental Association and College. New Alberta resident Leah Ettarh said that after opening her mail and finding two credit card receipts — for $59.45 and $174.32 — she thought her dentist had forgotten to bill her insurance company.

"I thought maybe there was a mix-up. That this is the receipt for the entire amount," Ettarh said.

Instead, the total bill for her and her son's two checkups was $901.

The $233.77 total on her two credit card receipts was the portion of the bill not covered by her insurance, which pays 80 per cent of what it considers reasonable.

Ettarh checked the prices her dentist charged for individual procedures and discovered that in every case, they were higher than what her insurance company, Equitable Life, was willing to pay.

For example, Ettarh's out-of-pocket expense for two bitewing X-rays, after her insurance paid its share, was $22.20.

That's about what she would have paid in B.C., had she paid cash, with no insurance coverage at all, according to that province's fee guide.

"I was shocked," Ettarh said. "You leave with sort of the feeling in your stomach that maybe you were ripped off."

Ettarh and her family had recently moved to Edmonton. Previously, they had lived in New Brunswick and British Columbia.

She said this was the first time she had been out of pocket a significant amount of money after seeing a dentist.

"Even in Vancouver, where you would assume costs are higher….our 20 per cent (that her insurance doesn't pay) rarely exceeded a few dollars."

Fees vary, but dentists reluctant to disclose them up front

Alberta is the only province without a dental fee guide, and dentists are free to set their prices at whatever level they choose.

Fees vary widely, even between neighbouring clinics, but patients such as Ettarh say it's hard to shop for the best prices because dentists are reluctant to reveal their fees until they have you in the chair.

Ettarh said she couldn't afford to use the same dentist again and began looking for one whose rates were within those covered by her insurance.

"I was never able get a simple answer for how much one basic service would cost," she said.

Albertans are paying dentists double or even triple what patients in other province pay, says Sharmin Hislop of Alberta Blue Cross (CBC) Ettarh said the first question she was always asked was whether she had insurance.

"It immediately tells me that there are different prices for those that have insurance or don't have insurance," she said.

The Alberta Dental Association and College, which promotes and regulates the profession, denies dentists charge more if you have insurance.

"It is actually unethical for a dentist to vary their fees based on whether a patient has insurance or not," said Randall Croutze, the provincial association and college's past president, and currently vice-president of the Canadian Dental Association.

Fees in Alberta 'extremely high', insurer says

There's no doubt Albertans are paying more for dental care, according to Sharmin Hislop of Alberta Blue Cross, a non-profit and the province's largest payer of dental services.

"Fees in Alberta are extremely high," Hislop said.

"In some cases double, sometimes even almost triple what other provinces' are."

According to a Blue Cross survey, a typical annual checkup for an adult costs $357.43 in Alberta.

The same visit costs on average $164.90 in B.C. and $192 in Saskatchewan.

Croutze doesn't believe Albertans pay more on average than people in other provinces.

"I don't think that's a very fair comment," he said.

"When I've taken a look at surveys of fees in other jurisdictions, there are fees that are higher and fees that are lower, depending on the service."

Lack of fee guide promotes price competition, profession says

When Alberta last had a fee guide, in 1997, it was seen by some as price fixing, Croutze said.

Croutze said the absence of a fee guide benefits Albertans by encouraging price competition.

He said dentists are reluctant to disclose their fees in advance because it's not possible to know what the final cost will be, even for routine checkup procedures.

"I don't think there is a routine sort of a thing," he said.

Croutze said the cost of a cleaning will vary according to the condition of a person's mouth, their hygiene, and whether they smoke.

What Alberta resident Leah Ettarh had to pay her dentist after insurance was almost as much as she would have paid in B.C. had she had no insurance at all. (CBC) "It's impossible to give a quote," he said.

Hislop said Blue Cross would prefer dentists to disclose their fees to patients up front.

"I think our plan members would love that," she said.

Hislop said Blue Cross has reimbursed plan members who, after receiving lower quotes, travelled to other provinces or even Mexico in search of cheaper dental care

Croutze said dentists always work to keep costs down.

"We are both," he said. "We're the business person and we're the health care provider and what we're doing is walking that fine line between the two and as a result of that we're always making sure there's good value."

Croutze said the best way for a person to control dental costs is to use good oral hygiene, by brushing and flossing regularly and avoiding smoking.

Health minister to review dental costs with college

Sarah Hoffman, Alberta's health minister, said getting rid of the fee guide in 1997 may have been intended as way to lower costs, but instead, they have risen faster here than elsewhere.

"This is definitely something I look forward to exploring more deeply," Hoffman said, noting that government had the power to influence dentists' fees before 1997.

"I'm committed to making sure that we do a review," she said.

"Maybe it's a fee guide. Maybe there are other solutions, but it's something I intend to explore in the coming months and the college will be a part of those discussions."

Ettarh said that since moving to Alberta, she has had to adjust to thinking like a dental consumer instead of a dental patient.

"I think it's very odd," she said.

"In Alberta, looking for a dentist is not like looking for a family doctor. It's kind of like shopping for a used car."