Dental Claim Appeals

Eligibility

If you are concerned about the income used to determine your dental benefits and as a result were denied funding of a dental claim or were funded less than expected, you may request a review. The review process is as follows:

• First, contact the Ministry for an explanation of the income information used. A review of the income information will be done and an explanation provided.
• If you disagree with the decision, please write the director of the Dental Assistance for Seniors program requesting a written review at:
  • Seniors Services Division
    Box 3100, Station Main
    Edmonton, Alberta  T5J 4W3

• If you don't agree with the written response, you may appeal in writing to the Dental Review Committee. The Dental Review Committee includes the manager and director of the Dental Assistance for Seniors program and one member from the benefit administrator. The decision of the Dental Review Committee is final.

Claims

If you have any questions regarding the adjudication of the dental claim or the amount of a payment, contact the  benefit administrator. The benefit administrator will follow these steps:

• A supervisor will review the claims adjudication by comparing the decision to the standard list of procedures and limitations. If there are discretionary options identified, the supervisor determines whether it is appropriate to apply discretion in this case.
• If you still disagree with the supervisor's decision or the supervisor needs expert advice, the situation is referred to a consulting dentist, who reviews the case and makes a decision.
• If you disagree with the decision of the consulting dentist, you may appeal in writing to the Dental Review Committee.