{"id":64188,"date":"2025-07-14T06:32:14","date_gmt":"2025-07-14T06:32:14","guid":{"rendered":"https:\/\/www.europesays.com\/us\/64188\/"},"modified":"2025-07-14T06:32:14","modified_gmt":"2025-07-14T06:32:14","slug":"half-of-requests-for-complex-dental-work-are-being-rejected-under-national-insurance-plan","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/64188\/","title":{"rendered":"Half of requests for complex dental work are being rejected under national insurance plan"},"content":{"rendered":"

As federal dental care expands to cover most uninsured Canadians, providers say some procedures are being bogged down by paperwork and\u00a0processing delays.<\/p>\n

Health Canada says 52 per cent of requests for pre-authorized dental work between November 2024 and June 2025 have been rejected.<\/p>\n

While the vast majority of claims don’t need pre-authorization, it’s\u00a0required for more complex and often more expensive procedures, like crowns or partial dentures. Clinics must submit extra documentation like X-rays and dental charts to show the work is medically necessary before it can be covered and completed.<\/p>\n

“There’s been a lot of confusion for dentists who send in what we would normally send in to a private plan, and it comes back rejected,” said Dr. Bruce Ward, a Vancouver dentist and president of the Canadian Dental Association.<\/p>\n

“It’s a much, much, much higher rejection rate than private plans.”<\/p>\n

The multibillion-dollar Canadian Dental Care Plan helps cover the cost of dental work for Canadian residents with a family income below $90,000 who don’t have access to private insurance. The program fully expanded to cover people aged 18 to 64 last month.<\/p>\n

Health Canada says 5.2 million people have been approved for coverage so far, but only about half \u2014 2.2 million \u2014 have received care.<\/p>\n

And some new patients are getting\u00a0an unexpected bill, while certain parts of the country\u00a0are struggling to keep up with a huge influx of appointments, Ward said.<\/p>\n

Still, providers told CBC News the program is providing Canadians much-needed access to care \u2014 and that issues with the program are improving.<\/p>\n

Missing information<\/p>\n

Clinics submit the pre-authorizations through Sun Life, the insurance provider that the federal government contracted to run the program.<\/p>\n

Dental offices are sometimes waiting weeks or months for a response, only to be told Sun Life needs\u00a0additional documentation \u2014 further slowing down the process, Ward\u00a0said.<\/p>\n

“A lot of people have been waiting for crowns to be pre-authorized,” Ward said. “There was an avalanche of approvals that got sent in.”<\/p>\n

\"AOral health-care providers say the influx of new patients in the federal program has led to some backlogs in appointments. (Justin Tang\/The Canadian Press)<\/p>\n

Health Canada said rejections and delays in pre-authorizations are caused by several factors, including an unexpected high volume of submissions that were missing information.<\/p>\n

Oral health-care providers also tell CBC\u00a0News\u00a0there were many\u00a0technical issues with the submission software that have since been largely resolved.<\/p>\n

Health Canada has worked to streamline the process and educate providers about how to complete the applications, a\u00a0spokesperson said.<\/p>\n

Eighty per cent of the pre-authorizations are now being processed within seven\u00a0business days. And\u00a0more than 90 per cent of the claims,\u00a0like basic cleanings or fillings,\u00a0don’t require pre-authorization.<\/p>\n

But Donna\u00a0Wells, manager of professional practice at the Canadian Dental Hygienists Association, said the program needs to better cover preventive care.<\/p>\n

The plan currently allots one hour of scaling per year for adults. Teenagers get just 15 minutes of scaling.<\/p>\n

“These are patients who have not had oral health care, in some cases, for a number of years, because it’s been such a financial barrier for them,” Wells said.<\/p>\n

She said pre-authorization applications for additional scaling are being rejected en masse.<\/p>\n

Growing pains<\/p>\n

Health Canada says over a million Canadians signed on to the program when it expanded in June, and\u00a094,980 of them received dental care.<\/p>\n

But that influx of patients has led to a backlog in some parts of the country, like Atlantic Canada.<\/p>\n

WATCH | From May 2024: Dental care program begins:\u00a0<\/strong>\"\"<\/p>\n

First phase of Canada’s national dental care plan begins<\/p>\n

The first phase of the Canadian Dental Care Plan began on May 1, providing coverage to nearly two million seniors aged 70 and older.<\/p>\n

“This program is wonderful, but it’s putting a strain on providers,” said Natalie Marsh, a dental assistant in North Sydney, N.S., and vice-president of the Canadian Dental Assistants Association.<\/p>\n

She said her clinic is already booking appointments for spring 2026.<\/p>\n

“You’re seeing people who haven’t seen a dentist in a long time. So they’re coming in with a lot of work to be done,” she said.<\/p>\n

Not a ‘free’ program<\/p>\n

Providers said patients continue to be under the impression their dental work will be free of charge. But the program reimburses clinics at a rate lower than provincial fee guides, which they often use to set their rates.<\/p>\n

That means dental offices can “balance bill,” charging the difference between the price of the procedure and what Ottawa will pay them.<\/p>\n

“I just had somebody in my office a couple of weeks ago who was very upset, because they’d been told that they were covered 100 per cent,” Ward said.\u00a0<\/p>\n

Ward said patients, including seniors, should remember they need to reapply every year.<\/p>\n

Despite those challenges, Ward said overall he’s found the dental care plan to be “very good” to work with. That sentiment is echoed by other oral health associations.<\/p>\n

“It’s been a huge boon to a lot of people who frankly would never have been able to afford to have their mouths taken care of,” Ward\u00a0said.<\/p>\n

“It’s remarkable,” he said. “And yes, there’s going to be some growing pains.”<\/p>\n","protected":false},"excerpt":{"rendered":"As federal dental care expands to cover most uninsured Canadians, providers say some procedures are being bogged down…\n","protected":false},"author":3,"featured_media":64189,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,1142,67,132,68],"class_list":{"0":"post-64188","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-united-states","12":"tag-unitedstates","13":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/114850191546860655","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/64188","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=64188"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/64188\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/64189"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=64188"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=64188"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=64188"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}