Requesting an exception for seniors' dental and optical claims

If you have submitted a dental or optical claim and are dissatisfied with the decision made, you can request an exception review.

Dental claim exceptions

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 Alberta Supports Contact Centre toll-free at 1-877-644-9992 and request an explanation of the income information used.
  • If you still disagree with the income used, you must write to the Dental Assistance for seniors program requesting a written review.
  • The income information used to determine eligibility will be reviewed and you will be notified of the decision in writing.

Claims

If you have any questions regarding the adjudication of the dental claim or the amount of a payment:

  • First, contact the Alberta Dental Service Corporation (ADSC) by telephone at 1-800- 232-1997, or by visiting the Alberta Dental Service Corporation website, for an explanation of how the claim was adjudicated.
  • If you disagree with the explanation, please write to ADSC requesting a written review. Your dental provider may also submit a request on your behalf. The dental provider will need to submit a treatment plan and all supporting documents for review and consideration.
  • ADSC will review the claims adjudication by comparing the decision to policies. If expert advice is needed, the matter is referred to a consulting dentist, who reviews the case. If there are discretionary options identified, the executive director of the dental program determines whether it is appropriate to apply discretion in this case.

Optical claim exceptions

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

  • First, contact the Alberta Supports Contact Centre toll-free at 1-877-644-9992 and request an explanation of the income information used.
  • If you still disagree with the income used, you must write to the Optical Assistance for Seniors program requesting a written review.
  • The income information used to determine eligibility will be reviewed and you will be notified of the decision in writing.

Claims

If you have any questions regarding the adjudication of the optical claim or the amount of a payment:

  • First, contact Alberta Blue Cross by telephone at 1-800-661-6995 or by visiting the Alberta Blue Cross website, for an explanation of how the claim was adjudicated.
  • If you disagree with the explanation, please write to the Optical Assistance for Seniors program requesting a written review.
  • The executive director will review the claims adjudication by comparing the decision to policies and make a decision. If there are discretionary options identified, the executive director determines whether it is appropriate to apply discretion in this case.