(EDITORS’ NOTE: We have a clarification on a story we brought you about a Ukrainian refugee in dire need of dental work under a provincial program.
The patient does need about $12,000 of work but after some back and forth with the provincial agency that assesses coverage, the dentist eventually submitted a claim for a fraction of the total amount involving only the most seriously damaged tooth.
They are still waiting on a response.)
A Ukrainian mother and newcomer to Alberta has waited more than two months for the provincial government’s dental corporation to make a decision on a $12,000 claim for procedures, as she continues to deal with an excruciatingly painful toothache.
Tetiana Kliuchishcheva evacuated from Ukraine amid the Russian invasion and arrived in Calgary nearly a year ago.
The 30-year-old single parent has been working to support her young son, which means some expenses, like dental care, have to be prioritized.
“I’m a single mom, I live alone and I cannot pay for this procedure myself. I need to pay for rent, I need to pay for my program after school and also I need to buy groceries,” she said.
On Nov. 9, Kliuchishcheva couldn’t take the pain any longer and sought treatment at a Calgary clinic, which submitted a request for the filling of multiple root canals and the installation of a crown on a separate tooth.
Kliuchishcheva received x-rays and was diagnosed with a severe toothache, swelling, reddening of the gums and an infection. Work needed to repair the damage would require four claims submitted to insurance totalling $12,247.
Kliuchishcheva, who qualifies for dental care under the Alberta Health Benefits’ Ukrainian Evacuees Program, submitted the claims to the Alberta Dental Service Corporation (ADSC), which is the provincial body who reviews it.
She was told it would be a three week wait, but two months later is still without an answer as to whether or not she can get the care she needs.
During that time, she’s taken three rounds of antibiotics, painkillers and missed work due to her extreme pain.
“This situation is an emergency. I need help now. I cannot wait. I want them to please look at my application but I am not getting an answer,” said Kliuchishcheva.
“This will cost lots of money and I don’t want to stay at a hospital, I cannot wait.”
It has taken so long to receive an answer from the ADSC, that the dental facility where Kliuchishcheva received her X-rays has now penned a letter to the Alberta Audit Health Benefit Exception Committee.
On Dec. 28, 2023, the clinic stated that Kliuchishcheva was in dire need of root canal therapy on her tooth.
“The patient is in excruciating pain, as there is a very large restoration in that tooth, with marginal decay into the nerve,” read the letter.
“She is currently on antibiotics and painkillers and has been for months now. She desperately needs to save this tooth. Please approve treatment.”
“IT BREAKS MY HEART”: UKRAINIAN HOST FAMILY MEMBER
Heather Basaraba is a Calgary school teacher who opened her family’s doors to Ukrainian evacuees out of the goodness of her heart.
In January of last year, she welcomed Kliuchishcheva and her son, Dmytro to their home.
“They’re part of our family now and I’ve just been blessed to have them join us, but their hardships are our hardships as well,” Basaraba said.
“Seeing someone try and navigate services when they are just learning English, it breaks my heart.”
Basaraba has been advocating for Kliuchishcheva, facilitating communication between the clinic and the ADSC.
She says their original claim submitted to the ADSC was deemed incomplete and returned in December because tooth x-rays showed up blurry.
It was then resubmitted with clearer tooth x-rays on Dec. 28, 2023 – x-rays that Kliuchishcheva had to pay for out of pocket.
“That’s her grocery bill gone,” said Basaraba. “And now you’re asking all these other newcomers to pay extra while navigating this complex system.”
Tetiana Kliuchishcheva evacuated from Ukraine amid the Russian invasion.Still, no decision has been made yet as to whether or not the thousands of dollars worth of dental procedures can be covered by insurance.
Basaraba has since called 811 to look for other treatment options and helped with translation to advocate for care as best as she could, but the wait continues.
“It’s just been a ping pong game between the clinic and the dental corporation,” she said.
“This has been more than a couple months now, and something’s got to be done. You know, she deserves it. All of our newcomers and individuals with low income deserve better.”
Basaraba has considered paying for the procedure, but the cost is far too expensive to pay all at once.
“You just don’t have the available credit and there’s not often dental offices that can do a payment program either so we’re really caught in a difficult place.”
“If Canada values immigration, they would make sure that the services follow the individual wherever they are, so If they are coming from a country that might not have the same access to dental care, or medical care or education, make sure we get the same services for our newcomers.”
100 PER CENT COVERAGE OFFERED FOR ‘ELIGIBLE’ DENTAL SERVICE: ALBERTA HEALTH
In March 2022, the federal government announced special measures to support the people of Ukraine, including the Canada-Ukraine Authorization for Emergency (CUAET) Travel visa, which provides Ukrainians and their family members extended temporary status, but not refugee status.
It means those who apply will receive an Alberta Health Card, an information guide in multiple languages on Alberta Health Benefits and an application to apply for extended benefits.
The extended benefits are under the Alberta Health Benefits Ukrainian Evacuees Program which is a choice, so not everyone will receive an application form automatically.
Alberta offers these supports only to Ukrainian evacuees who enter Alberta with a Canada-Ukraine Authorization for Emergency Travel visa.
Those who obtain an Alberta Health Benefits card will be required to show it to a health-care provider ahead of seeking treatment.
The province says that when using the card, there will be no out-of-pocket costs for benefits ‘covered’ under the program.
“The Ukrainian Evacuee Alberta Health Benefit program provides coverage for prescription drugs, eye exams and glasses, dental care, essential diabetic supplies and emergency ambulance services,” reads a statement from Alberta Health.
“The program provides 100 per cent coverage for eligible dental services. Clients who are seeking coverage for dental services that are not eligible benefits under the program can have their dental provider submit a request for coverage to the Alberta Dental Service Corporation Review Committee.”
The statement goes on to say that the ADSC Review Committee will review the proposed dental treatment plan, medical rationale and supporting diagnostic information and then provide a decision to the dental provider.
Following that review by the ADSC, an exception request may be submitted to the Health Benefits Exception Committee for further review and decision on coverage.
The Alberta Health Benefits Program has been extended until April 30.
CTV News has followed up with Alberta Health to ask what kind of dental procedures Ukrainian evacuees are eligible for and if there is a time limit on how long a decision can be made by the ADSC to review a claim.
We will update this story once we receive a further response.
ALBERTA DENTAL ASSOCIATION CALLS FOR SIMPLER APPLICATION PROCESS
The Alberta Dental Association (ADA) is calling on both provincial and federal governments to provide more clarity for eligible applicants seeking dental care.
ADA president Dr. Bruce Yaholnitsky says no dentist wants to see any of their patients in pain.
“As the need for dental assistance programs continues to grow, cases like this highlight the extreme need for both the provincial and federal government to clarify how these programs run and to simplify the application process,” he said.
“Reducing the administrative burden for dental assistance programs will help dentists treat patients faster which means less pain and waiting for those in need of relief.”
All of this comes as the federal government’s national dental coverage program continued its roll out this week.
A new report from the Canadian Centre for Policy Alternatives (CCPA) argues that the plan leaves too many Canadians without coverage and needs an additional $1.45 billion in funding.
In order to qualify for the Canadian Dental Care Plan — the national dental care insurance offering brought about as a part of the supply-and-confidence agreement between the Liberals and the NDP — applicants must have a household income of less than $90,000 and have no existing dental insurance.
But in its “Missing Teeth” report released Tuesday, the CCPA says the income criteria is too restrictive.
“A $45,000 salary for each parent in a two-parent household isn’t a king’s ransom in Canada,” CCPA senior economist David Macdonald said in a news release Monday. “In fact, 59 per cent of families with children make over $90,000, but making more than that excludes families from receiving federal dental care coverage.”