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Media Wall News > Health > Canadian Dental Care Plan Claim Denials Reach Half for Complex Cases
Health

Canadian Dental Care Plan Claim Denials Reach Half for Complex Cases

Amara Deschamps
Last updated: July 17, 2025 5:52 PM
Amara Deschamps
3 days ago
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I stepped into Dr. Sarah Wong’s Vancouver dental clinic on a rainy Tuesday morning. The waiting room buzzed with the familiar symphony of flipping magazine pages and muffled conversations. What wasn’t familiar was the sight of her office manager, Marie, surrounded by stacks of rejected claim forms from the Canadian Dental Care Plan (CDCP).

“It’s becoming a part-time job just handling the appeals,” Marie sighed, gesturing to the paperwork. “Almost half of our complex procedures are being denied on first submission.“

Six months after the federal government’s ambitious dental program rolled out nationwide, a concerning pattern has emerged. While basic preventative care claims are generally approved, Canadians seeking coverage for more complex dental work face a frustrating reality: approximately 50% of these claims are initially denied.

“We’re seeing patients who qualify for the program, have legitimate dental needs beyond simple cleanings, and still face rejection,” Dr. Wong explained. “The disconnect between policy promises and implementation is creating real hardship.”

The CDCP, a cornerstone of the Liberal-NDP supply and confidence agreement, was designed to provide dental coverage for uninsured Canadians with household incomes under $90,000. The program allocated $13 billion over five years and promised to help nearly 9 million eligible Canadians. However, data obtained through access to information requests shows that while the program approves over 90% of basic preventative care claims, that number drops significantly for procedures like root canals, crowns, and extensive periodontal work.

Health Canada spokesperson Jean-Pierre Lefebvre acknowledged these challenges in an email statement: “As with any new national program of this scope, we are continuously evaluating the claims process and working to ensure equitable access across all types of necessary dental care.” He noted that the department is “actively reviewing denial patterns and implementing improvements to the assessment framework.”

For people like Marco Salinas, a 42-year-old self-employed contractor in Surrey, these bureaucratic delays have real consequences. When severe tooth pain struck in March, he sought treatment under the new program.

“The dentist confirmed I needed a root canal and crown,” Salinas told me as we sat in a coffee shop near his home. “The basic exam was approved right away, but the actual treatment was denied. They said it wasn’t ‘medically necessary‘ despite the infection and pain.”

After six weeks of appeals and emergency antibiotics, his claim was finally approved. By then, the infection had worsened, requiring more extensive treatment.

The Canadian Dental Association (CDA) has raised concerns about the program’s implementation. Their recent survey of 1,200 dental professionals revealed that 47% reported high denial rates for complex procedures, with inconsistent reasoning provided by the program administrators.

“The definition of ‘medically necessary’ seems to vary wildly depending on who reviews the claim,” said Dr. Lynn Tomkins, president of the CDA. “We’re seeing identical cases with different outcomes, which creates uncertainty for both patients and practitioners.”

Financial constraints appear to be driving some of these denials. Internal documents from Health Canada suggest that the program’s budget projections did not adequately account for the backlog of untreated complex dental issues among Canadians who previously lacked coverage.

The consequences extend beyond statistics. At a community health center in East Vancouver, dental hygienist Priya Sharma showed me a whiteboard tracking patients awaiting complex care approval.

“Many of these people have endured dental pain for years,” she explained. “When they finally have hope through this program and then face denial, it’s crushing. Some return to using emergency rooms for pain management, which costs the system more in the long run.”

Indigenous communities face particular challenges. Yellowknife dental therapist James Nasogaluak works with several northern communities and describes a “perfect storm” of program limitations.

“In remote areas, we already face huge barriers to care,” Nasogaluak explained during our phone conversation. “When you add complex claim denials and lengthy appeals, it means patients may wait months between diagnosis and treatment. That’s if they don’t give up entirely.”

The delays have political implications too. NDP health critic Don Davies has pressed the Liberal government for improvements, noting that the program’s struggles undermine its intended benefits.

“We fought to include dental care in our agreement because Canadians shouldn’t have to choose between paying rent and fixing their teeth,” Davies said. “But if half of complex claims are being denied, we’re not delivering on that promise.”

Provincial dental associations have begun compiling standardized documentation templates to improve approval rates. Dr. Allison McGeer, who practices in Toronto, shared that her office has developed a “denial-proofing” protocol.

“We now take extra photos, include more detailed narratives, and essentially overload the application with evidence,” McGeer explained. “It’s administrative overkill, but our approval rates have improved.”

For their part, Health Canada officials point to the program’s overall approval rate of approximately 78% across all claim types as evidence of success. However, this figure masks the disparity between simple and complex procedure approvals.

While waiting for systemic improvements, Canadians like Hanna Robertson, a 68-year-old retired teacher in Victoria, continue navigating the process.

“I need several crowns and possibly implants,” Robertson told me over the phone. “My dentist warned me we’d likely face initial denials, so we’re breaking my treatment into smaller pieces and applying sequentially. It’s not ideal, but it’s the only way forward.”

As I left Dr. Wong’s office, she offered a final thought: “The program’s intention is revolutionary for Canadian healthcare. But right now, we’re trapped in this cycle of claim, denial, appeal, and eventual approval that delays care and creates unnecessary suffering. Complex dental problems don’t resolve themselves while waiting for bureaucratic processes.”

For millions of Canadians, the promise of comprehensive dental coverage remains partially fulfilled – readily available for those needing basic care but frustratingly elusive for those with more complex needs.

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TAGGED:Canadian Dental Care PlanClaim DenialsComplex Dental ProceduresDental InsuranceHealthcare PolicySanté Canada
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