As federal dental care expands to cowl most uninsured Canadians, suppliers say some procedures are being slowed down by paperwork and processing delays.
Well being Canada says 52 per cent of requests for pre-authorized dental work between November 2024 and June 2025 have been rejected.
Whereas the overwhelming majority of claims do not want pre-authorization, it is required for extra advanced and infrequently costlier procedures, like crowns or partial dentures. Clinics should submit further documentation like X-rays and dental charts to indicate the work is medically mandatory earlier than it may be coated and accomplished.
“There’s been a whole lot of confusion for dentists who ship in what we’d usually ship in to a personal plan, and it comes again rejected,” mentioned Dr. Bruce Ward, a Vancouver dentist and president of the Canadian Dental Affiliation.
“It is a a lot, a lot, a lot increased rejection charge than non-public plans.”
The multibillion-dollar Canadian Dental Care Plan helps cowl the price of dental work for Canadian residents with a household earnings under $90,000 who do not have entry to non-public insurance coverage. This system totally expanded to cowl folks aged 18 to 64 final month.
Well being Canada says 5.2 million folks have been permitted for protection to date, however solely about half — 2.2 million — have acquired care.
And a few new sufferers are getting an sudden invoice, whereas sure components of the nation are struggling to maintain up with an enormous inflow of appointments, Ward mentioned.
Nonetheless, suppliers advised CBC Information this system is offering Canadians much-needed entry to care — and that points with this system are enhancing.
Lacking info
Clinics submit the pre-authorizations by means of Solar Life, the insurance coverage supplier that the federal authorities contracted to run this system.
Dental places of work are generally ready weeks or months for a response, solely to be advised Solar Life wants extra documentation — additional slowing down the method, Ward mentioned.
“Lots of people have been ready for crowns to be pre-authorized,” Ward mentioned. “There was an avalanche of approvals that obtained despatched in.”
Oral health-care suppliers say the inflow of latest sufferers within the federal program has led to some backlogs in appointments. (Justin Tang/The Canadian Press)
Well being Canada mentioned rejections and delays in pre-authorizations are brought on by a number of elements, together with an sudden excessive quantity of submissions that had been lacking info.
Oral health-care suppliers additionally inform CBC Information there have been many technical points with the submission software program which have since been largely resolved.
Well being Canada has labored to streamline the method and educate suppliers about full the purposes, a spokesperson mentioned.
Eighty per cent of the pre-authorizations at the moment are being processed inside seven enterprise days. And greater than 90 per cent of the claims, like fundamental cleanings or fillings, do not require pre-authorization.
However Donna Wells, supervisor {of professional} follow on the Canadian Dental Hygienists Affiliation, mentioned this system wants to raised cowl preventive care.
The plan at present allots one hour of scaling per 12 months for adults. Youngsters get simply quarter-hour of scaling.
“These are sufferers who haven’t had oral well being care, in some instances, for quite a lot of years, as a result of it has been such a monetary barrier for them,” Wells mentioned.
She mentioned pre-authorization purposes for added scaling are being rejected en masse.
Rising pains
Well being Canada says over 1,000,000 Canadians signed on to this system when it expanded in June, and 94,980 of them acquired dental care.
However that inflow of sufferers has led to a backlog in some components of the nation, like Atlantic Canada.
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First part of Canada’s nationwide dental care plan begins
The primary part of the Canadian Dental Care Plan started on Could 1, offering protection to almost two million seniors aged 70 and older.
“This program is fantastic, however it’s placing a pressure on suppliers,” mentioned Natalie Marsh, a dental assistant in North Sydney, N.S., and vice-president of the Canadian Dental Assistants Affiliation.
She mentioned her clinic is already reserving appointments for spring 2026.
“You are seeing individuals who have not seen a dentist in a very long time. In order that they’re coming in with a whole lot of work to be achieved,” she mentioned.
Not a ‘free’ program
Suppliers mentioned sufferers proceed to be beneath the impression their dental work might be freed from cost. However this system reimburses clinics at a charge decrease than provincial charge guides, which they typically use to set their charges.
Meaning dental places of work can “steadiness invoice,” charging the distinction between the worth of the process and what Ottawa pays them.
“I simply had any person in my workplace a few weeks in the past who was very upset, as a result of they’d been advised that they had been coated 100 per cent,” Ward mentioned.
Ward mentioned sufferers, together with seniors, ought to bear in mind they should reapply yearly.
Regardless of these challenges, Ward mentioned total he is discovered the dental care plan to be “superb” to work with. That sentiment is echoed by different oral well being associations.
“It has been an enormous boon to lots of people who frankly would by no means have been in a position to afford to have their mouths taken care of,” Ward mentioned.
“It is exceptional,” he mentioned. “And sure, there’s going to be some rising pains.”
