In a recent complaint, a parent presented his child's BC Services card on arrival to a dental office, assuming the administrative staff would confirm their child's eligibility for the Healthy Kids program. A month later, the parent received a bill for the full amount of the services provided as the child was not covered by Healthy Kids at the time of treatment. The parent was shocked and unwilling to pay. Soon after, he received notification the file had been forwarded to a collections service, negatively impacting his credit rating. The dentist and his administrative staff believed it was the responsibility of the parent to confirm insurance coverage and that the parent was ultimately responsibile for the charges.
The question that needs to be answered is this: whose responsibility is it to confirm eligibility? It's an important question because not knowing the correct answer can have unintended negative outcomes.
Unlike private insurance where the patient is responsible for knowing their coverage, acceptance of British Columbia Employment and Assistance (BCEA) Program for adults or children or BC Healthy Kids Program benefits means the dentist is responsible for knowing coverage eligibility, looking up plan limits, and making sure there are funds available to pay for scheduled services. These programs are sponsored by the Ministry of Social Development and Poverty Reduction and contracted by Pacific Blue Cross.
Eligibility must be confirmed immediately prior to providing service (same day), as coverage can change from month to month. Coverage may even change within the month if, for example, a child ages out of coverage mid-month. All providers should be aware that patients and parents are unable to access this information.
Unfortunately, the child's parent, who had no culpability in the situation described, suffered an unintended and undeserved negative outcome.
It comes down to informed consent: if an office is planning to balance-bill a patient, the patient must understand this in advance of treatment and be given the choice about whether to proceed with care once coverage (or lack of it) has been determined. This will prevent inconvenience for all parties involved.
Dentists can access Pacific Blue Cross' provider resources at: www.pac.bluecross.ca/providerresource
Steps to confirm a patient's eligibility*:
From the desk of Dr. Kelly Wright (firstname.lastname@example.org)
Thanks to Policy Managers at Pacific Blue Cross for their input.
*See complete eligibility information for dental supplements at www2.gov.bc.ca/assets/gov/family-and-social-supports/income-assistance/on-assistance/schedule-dentist.pdf