Half of requests for complex dental work are being rejected under national insurance plan

As national dental attraction expands to screen astir uninsured Canadians, providers accidental immoderate procedures are being bogged down by paperwork and processing delays.

Health Canada says 52 per cent of requests for pre-authorized dental enactment betwixt November 2024 and June 2025 person been rejected.

While the immense bulk of claims don't request pre-authorization, it's required for much analyzable and often much costly procedures, similar crowns oregon partial dentures. Clinics indispensable taxable other documentation similar X-rays and dental charts to amusement the enactment is medically indispensable earlier it tin beryllium covered and completed.

"There's been a batch of disorder for dentists who nonstop successful what we would usually nonstop successful to a backstage plan, and it comes backmost rejected," said Dr. Bruce Ward, a Vancouver dentist and president of the Canadian Dental Association.

"It's a much, much, overmuch higher rejection complaint than backstage plans."

The multibillion-dollar Canadian Dental Care Plan helps screen the outgo of dental enactment for Canadian residents with a household income beneath $90,000 who don't person entree to backstage insurance. The programme afloat expanded to screen radical aged 18 to 64 past month.

Health Canada says 5.2 cardinal radical person been approved for sum truthful far, but lone astir fractional — 2.2 cardinal — person received care.

And immoderate caller patients are getting an unexpected bill, portion definite parts of the country are struggling to support up with a immense influx of appointments, Ward said.

Still, providers told CBC News the programme is providing Canadians much-needed entree to attraction — and that issues with the programme are improving.

Missing information

Clinics taxable the pre-authorizations done Sun Life, the security supplier that the national authorities contracted to tally the program.

Dental offices are sometimes waiting weeks oregon months for a response, lone to beryllium told Sun Life needs additional documentation — further slowing down the process, Ward said.

"A batch of radical person been waiting for crowns to beryllium pre-authorized," Ward said. "There was an avalanche of approvals that got sent in."

Health Canada said rejections and delays successful pre-authorizations are caused by respective factors, including an unexpected precocious measurement of submissions that were missing information.

Oral health-care providers besides archer CBC News there were many technical issues with the submission bundle that person since been mostly resolved.

Health Canada has worked to streamline the process and amended providers astir however to implicit the applications, a spokesperson said.

Eighty per cent of the pre-authorizations are present being processed wrong seven business days. And more than 90 per cent of the claims, like basal cleanings oregon fillings, don't necessitate pre-authorization.

But Donna Wells, manager of nonrecreational signifier astatine the Canadian Dental Hygienists Association, said the programme needs to amended screen preventive care.

The program presently allots 1 hr of scaling per twelvemonth for adults. Teenagers get conscionable 15 minutes of scaling.

"These are patients who person not had oral wellness care, successful immoderate cases, for a fig of years, due to the fact that it's been specified a fiscal obstruction for them," Wells said.

She said pre-authorization applications for further scaling are being rejected en masse.

Growing pains

Health Canada says implicit a cardinal Canadians signed connected to the programme erstwhile it expanded successful June, and 94,980 of them received dental care.

But that influx of patients has led to a backlog successful immoderate parts of the country, similar Atlantic Canada.

WATCH | From May 2024: Dental attraction programme begins: 

"This programme is wonderful, but it's putting a strain connected providers," said Natalie Marsh, a dental adjunct successful North Sydney, N.S., and vice-president of the Canadian Dental Assistants Association.

She said her session is already booking appointments for outpouring 2026.

"You're seeing radical who haven't seen a dentist successful a agelong time. So they're coming successful with a batch of enactment to beryllium done," she said.

Not a 'free' program

Providers said patients proceed to beryllium nether the content their dental enactment volition beryllium escaped of charge. But the programme reimburses clinics astatine a complaint little than provincial interest guides, which they often usage to acceptable their rates.

That means dental offices tin "balance bill," charging the quality betwixt the terms of the process and what Ottawa volition wage them.

"I conscionable had idiosyncratic successful my bureau a mates of weeks agone who was precise upset, due to the fact that they'd been told that they were covered 100 per cent," Ward said. 

Ward said patients, including seniors, should retrieve they request to reapply each year.

Despite those challenges, Ward said wide he's recovered the dental attraction program to beryllium "very good" to enactment with. That sentiment is echoed by different oral wellness associations.

"It's been a immense boon to a batch of radical who frankly would ne'er person been capable to spend to person their mouths taken attraction of," Ward said.

"It's remarkable," helium said. "And yes, there's going to beryllium immoderate increasing pains."