download a pdf of the statement pdf
download a pdf of the Dental implant Claim Denial Appeal Form pdf
JOINT COMMUNICATION
Multi-Employer/UNA Collective Agreement
Coverage for Dental Implants
June, 2008
Effective October 1, 2007, the Multi-Employer/UNA Collective Agreement language regarding the Dental Plan
was amended to provide for “…50% of eligible Extensive Services [including implants and appliances …].”
Subsequent to implementing this change, it was identified that the various dental plan providers were
adjudicating dental implant claims differently.
UNA filed grievances on behalf of five individuals who had had claims or preauthorization requests for dental
implants denied by the dental plan provider.
The issue of coverage for dental implants was discussed by the Multi-Employer/UNA Joint Committee and has
been resolved by the parties as follows:
1. Criteria for Coverage - Claims and pre-authorizations for dental implants are to be approved for payment, provided that they meet the agreed upon criteria:
(a) the dental implant is not be provided for cosmetic purposes (i.e. replacing a healthy tooth with an implant to improve appearance); and
(b) the provision of the dental implant must be reasonable and generally acceptable treatment in the standards of dental practice for the condition for which it is claimed or recommended.
2. Review of Previously Denied Claims - Employees who had a claim or preauthorization for a dental implant denied during the period between October 1, 2007 and June 19, 2008 have received or will be receiving a letter from the dental plan provider indicating that if they wish to have their claim readjudicated on the basis of the above agreed upon criteria, they should contact their UNA representative to initiate a review of their previously denied claim.
3. Ongoing Appeal Process – In the event that an Employee is denied coverage for a dental implant and feels that the provision of the implant meets the above agreed upon criteria for coverage, the Employee can appeal the claim denial through the Multi-Employer/UNA Joint Appeal Panel. Employees wishing to appeal a dental implant claim denial should contact their UNA representative to commence the appeal process.
If you have any questions regarding the resolution of this issue, please contact your applicable representative as follows:
For the Union:
David Harrigan
Director of Labour Relations
United Nurses of Alberta
1-800-252-9394
For the Employers:
Cory Galway
Senior Negotiator
HBA Services
403-281-8510
Director
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