Here's why half of the requests for complex dental work were reportedly denied by Canada's care plan

Half of the requests for preauthorized complex dental work have reportedly been denied by Canada’s dental care plan. Just over 50 per cent of requests for such dental work between November 2024 and June 2025 have been rejected, said Health Canada, per CBC News and Daily Hive . While 5.2 million people have been approved for coverage under the Canadian Dental Care Plan (CDCP), only about half  — 2.2 million people — have received care, according to the federal agency. The CDCP, which launched in 2023, is intended to make dental care more affordable for eligible Canadians. Any resident with an adjusted family net income below $90,000 a year and who does not have access to dental insurance can apply. It is administered by a contracted third-party, insurance provider Sun Life. Complex dental work can include procedures like putting in crowns or partial dentures, root canals, specialist examinations and other kinds of oral surgery. These services require preauthorization. The approval process is different than private insurance plans, per Health Canada. “T he CDCP coverage criteria are more stringent,” it says online. Supporting documentation is required to prove the work is medically necessary before it can be covered. “There’s been a lot of confusion for dentists who send in what we would normally send in to a private plan, and it comes back rejected,” Vancouver dentist and president of the Canadian Dental Association Dr. Bruce Ward told CBC News . “It’s a much, much, much higher rejection rate than private plans.” Ward still commended the plan, calling it “very good.” He added that despite its “growing pains” it was still remarkable and noted the influx of people who would have otherwise gone without oral health care because they couldn’t afford it. Meanwhile, spokesperson for Health Canada and the Public Health Agency of Canada Mark Johnson told Daily Hive that incomplete submissions made up a large part of the preauthorized requests that had been denied between November 2024 and June. The rejection rate went from 52 per cent to 38 per cent when the incomplete submissions were excluded. “Common reasons for denial (were) incomplete submission, the patient’s needs not meeting the clinical criteria for coverage, the request being a duplicate submission that was already approved previously, or the service requested not being eligible under the plan,” Johnson said in a statement to the publication. There was also a backlog causing preauthorization delays due to technical issues and a high volume of submissions. However, as of July 11, Johnson said 80 per cent of preauthorization requests are now being processed within seven days. A new wave of applicants applied to the CDCP when it expanded in June . More than a million people signed up and 94,980 received care, according to Health Canada, CBC News reported. Vice-president of the Canadian Dental Assistants Association Natalie Marsh, who is a dental assistant in North Sydney, N.S., told CBC that the plan was “wonderful” but it did put a strain on some providers. “You’re seeing people who haven’t seen a dentist in a long time. So they’re coming in with a lot of work to be done,” she said.

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