The new Canadian Dental Care Plan, which started on May 1, 2023, has already given dental coverage to over 1.7 million seniors 70 years and older. It’s at a precarious crossroads. Reports suggest that even these restricted requests for more specialized and complex dental work are being denied at half of the claims filed under the plan. Last month, this state initiative took the vital step of extending coverage to all adults, ages 18-64. As a direct result, the system has been inundated with a tidal wave of applications.
Senior reporter Marina von Stackelberg of CBC’s Parliamentary Bureau in Ottawa highlights the growing concerns from both dental professionals and patients. Since the program was expanded in June, more than a million Canadians have registered. In turn, the need for dental services has skyrocketed, but so has the headache of navigating the pre-authorization process for procedures.
Increased Demand and Growing Pains
The Canadian Dental Care Plan has already proven to be an effective measure to increase Canadians’ access to care. Because of this expansion, 94,980 Canadians have been treated. The proposal only allows adults to climb for one hour each day, which just isn’t enough. For teenagers, it’s an even more restrictive window, an average of just 15 minutes. As Dr. Bruce Ward, a Vancouver dentist and president of the Canadian Dental Association, rightly notes, he suspects the burden of these restrictions is contributing to their high rejection rates.
As Dr. Ward goes on to detail, understandably, many dentists are scratching their heads. They submit claims just like they would under a private plan, but those claims get denied. He goes on to explain, “It’s a … higher rejection rate than private plans. That kind of confusion is contributing to increased wait times for dentists and patients alike.
Health Canada has previously cited reasons for this rejection and delay including. One other perennial complaint is the surprising number of submissions that fail to provide basic required information. Today, dental offices often wait several weeks or even months for responses. When they do hear back, they’re surprised to learn that they need to provide even more documentation. This has led to increased scrutiny over the effectiveness of the system.
Strain on Dental Providers
The fast rollout of the program is putting a lot of pressure on dental providers nationally. Natalie Marsh, a dental assistant in North Sydney, N.S., who serves as vice-president of the Canadian Dental Assistants Association. While Cures provides a multitude of advantages, she points out that the program poses substantial challenges to providers. “This is a great program, but it is stretching providers thin,” she says.
Marsh highlights the importance of holistic dental care for patients who have missed treatment for times often due to cost-related obstacles. And you’re getting people who haven’t been able to see a dentist for years. So they’re coming in with an expectation of a lot of heavy lifting and heavy work to be done,” she adds. As a result, millions of patients can no longer avoid surprise bills. Dental offices can “balance bill,” charging them the difference between the procedure’s cost and what Ottawa pays.
Dr. Ward expresses his frustration over the continued pain points associated with the preauthorization process. He recounts an instance where a patient was misinformed about their coverage: “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.”
Looking Ahead
Though these roadblocks may seem discouraging, there’s reason to be hopeful about the long-run impact the Canadian Dental Care Plan will have in increasing accessibility to oral health care. Dr. Ward is proud to have helped build something that has undeniably been a great boon for most Canadians. He explains that, “It’s done a world of good for a lot of people…these folks would never have gotten dental care otherwise.”
Even he admits that as the program continues, changes need to be made. He acknowledges, “And yes, there’s going to be some growing pains.” The Canadian Dental Association has been working closely with Health Canada to address these issues. Through such efforts, they hope to improve the transparency and efficiency of the pre-authorization process.
