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On June 1, Canadians aged 18 to 64 became eligible for coverage under Ottawa’s subsidized dental care plan.
Dental associations across Canada are flagging concerns with the plan’s structure and sustainability.
They say the Canadian Dental Care Plan imposes significant administrative burdens on dentists, and that the majority of eligible patients are being denied care for complex dental treatments.
“Patients are coming to see us because they require care, and … this erodes trust and predictability of the program if much treatment isn’t being approved,” said Dr. Anita Gartner, president of the British Columbia Dental Association.
‘Unnecessary hassle’
In 2023, Ottawa announced that it would implement a Canadian Dental Care Plan to cover dental costs for an estimated nine million Canadians. The plan covers Canadians without dental insurance who have an annual family net income under $90,000.
Ottawa launched the plan to different age groups in stages, beginning in May 2024. Starting June 1 of this year, eligible Canadians of all ages could begin receiving coverage.
Dr. Maneesh Jain, who recently stepped down as president of the Ontario Dental Association, says dental associations have been advocating for years for better access and funding for public dental programs.
“[Ottawa’s plan] is a step in the right direction,” he said. “But obviously we have some concerns.”
One concern is the administrative burden the plan places on dentists.
To participate in the plan, individuals must first apply through the government’s portal. Jain says it can take weeks or months before the insurer Sun Life confirms a patient’s eligibility and the amount of their coverage. Ottawa selected Sun Life to manage and adjudicate its dental care plan.
If a family makes less than $70,000, they are fully covered. If they earn between $70,000 and $90,000, the patient pays between 40 and 60 per cent of the treatment cost.
Some dentists refuse to provide treatment until they receive confirmation from Sun Life — a practice Health Canada discourages for treatments that do not require pre-authorization from Sun Life. These treatments typically include more basic dental procedures, such as cleanings or fillings.
Other dentists provide care immediately, but then have to follow-up with patients for any co-pay or additional fees.
“Our front desk staff then has to call the patient. [The patient has] got to either come back in or take a payment over the phone,” said Jain. “It’s an unnecessary hassle.”
Even once individuals are enrolled in the plan, dentists cannot access this information quickly — as they do with privately insured patients — due to delays in Sun Life’s electronic processing systems, Jain says.
This puts dentists in the “very awkward spot” of having to verify a patient’s family income, says Dr. Hans Herchen, president of the Alberta Dental Association. “We believe the patient’s income should not be known to the dental office.”
Mark Johnson, a spokesperson for Health Canada, told Canadian Affairs in an email that, “Sun Life is currently experiencing a high volume of requests for both claims and preauthorizations, and turnaround times are currently longer than expected.”
But the “majority of requests are now processed within a one- or two-week timeframe,” Johnson added.
Dental offices also spend significant time explaining the plan to patients, says Jain. The plan covers fees according to a federal schedule, which is often below provincial guidelines. Patients are required to pay the difference, in addition to any co-pay they must pay based on their income.
Most patients are not aware that they will be required to pay a fee.
Jain attributes patients’ misunderstanding to “poor” and “misleading” messaging from Ottawa. “[Health Canada] should have just been honest and said that this is a dental care subsidy,” he said.
Johnson, Health Canada’s spokesperson, said, “Services covered under the CDCP are not free. … Health Canada has been working to make sure this is well understood since the launch of the plan.”
Gartner, of the British Columbia Dental Association, says most patients are understanding when they learn they must pay a fee.
“People have been accepting and have said, ‘Well, something is better than nothing’,” she said.
High rejection rate
The dental associations also raised concerns about the plan’s coverage of pre-authorized treatments.
Under the plan, patients are required to be pre-authorized by Sun Life for treatment for complex dental work, such as root canals, dentures and crowns.
Sun Life is rejecting a majority of applications for complex treatment without explanation, says Gartner.
“Only [an average of] 30 per cent of dentists report that their … pre-authorization treatment requests to Sun Life are actually being approved,” said Gartner, citing a Canadian Dental Association survey.
“Unfortunately, many of these denials lack any explanation or guidance from Sun Life.”
Herchen, of the Alberta Dental Association, says he has heard of colleagues experiencing rejection rates as high as 90 per cent.
The rejections “puts us all in a bind,” said Gartner. “We’re looking at it going, ‘I don’t understand why it’s not being approved,’ and that means patients are not receiving the care that they need.”
Johnson, of Health Canada, said the claim that 70 per cent of pre-authorized treatment requests are not approved is “not accurate.”
Over the week of May 30 to June 5, half of all processed pre-authorized treatment requests were approved when “all supporting documentation was provided,” he said.
The Canadian Dental Association told Canadian Affairs in an email that the top reasons for pre-authorized treatments being denied are technical errors in Sun Life’s systems and lack of clarity around the documentation a dental clinic is required to submit.
Health Canada and Sun Life have only recently “implemented a new measure that provides further explanation on the reasons for denials,” their statement said.
A spokesperson for Sun Life told Canadian Affairs that all requests related to the Canadian Dental Care Plan should be directed to Health Canada.
‘The plan is unsustainable’
The Canadian Dental Care Plan is unsustainable in its current form, says Herchen.
In its 2023 budget, Ottawa allocated about $13 billion for the plan to cover about nine million Canadians over five years. This would amount to spending about $280 for each eligible Canadian a year.
But Health Canada has said patients saved an average of more than $850 in the plan’s first year, Jain says.
“So now you’ve tripled the cost of the program,” Jain said. “So instead of $13 billion, now it’s close to $35 billion, is what we’ve estimated.”
The real cost of the plan “is not yet in the budget, and realistically, may never be in the budget,” said Herchen.
Health Canada did not directly respond to claims about funding levels for the plan.
Carney’s Liberal government has promised to release a budget in the fall that is expected to include funding for the Canadian Dental Care Plan.
Gartner hopes the program can improve with time — and become permanent.
“It’s still a work in progress,” said Gartner. “We’re trying to concentrate on what the positive is, and to see how we can work and how we can actually develop an even better program for Canadians.”
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