Ottawa allows dentists to bill federal insurance plan on case-by-case basis

As of today, oral health-care providers can treat patients under the Canadian Dental Care Plan (CDCP) on a case-by-case basis without officially signing up for the program.

Ottawa introduced the measure in the hope that it would convince more dentists to take part in the new national public insurance plan.

“You can just try it out, submit a claim and see what you think,” Health Minister Mark Holland told a press conference in Dartmouth, N.S., on Monday.

The change means patients who qualify for the CDCP may be able to stay at their current dental clinic, even if their dentist isn’t a registered provider.

But patients must check to see if their dentist is willing to accept them, Health Canada officials cautioned. Oral health care providers aren’t required to process claims through the plan, since their participation is voluntary.

More than two million people have been approved for coverage so far under the publicly-funded dental care plan, which is meant to eventually cover nine million low and middle-income Canadian residents without private coverage.

Dentists must still submit claim on patient’s behalf

To bill on a case-by-case basis, providers must agree to submit claims directly to Sun Life, the insurance company the federal government contracted to run the program. Dentists can’t ask their patients to pay the full cost up front.

“We have certain providers who are handing over Sun Life forms and saying, ‘You go send this in and you go pay for it.'” Holland said.

Holland said some patients who are covered can’t afford to pay out of pocket. Patients who try to submit a claim on their own behalf after treatment won’t be reimbursed.

In most cases, oral health-care providers are being paid back within 48 hours, he added.

Dental professionals must also still agree to a claims and processing agreement, Holland said. That allows Ottawa to investigate fraudulent claims and is similar to how private dental plans work, he said.

“We have no interest in auditing anybody unless there is evidence of malfeasance,” Holland said.

Just under 40 per cent of providers signed up

The contract has been a major sore spot for dental associations, which say today’s changes don’t fix the problem.

“When you submit the claim, you’re accepting the exact same terms, conditions and contracts,” said Dr. Joel Antel, a Winnipeg dentist and head of the Canadian Dental Association.

Despite the concerns, the number of professionals fully registered is growing— 11,800 oral health-care providers have now signed up, officials said Monday. That’s slightly less than 40 per cent of all dental professionals in the country, and includes dentists, independent hygienists, denturists and dental specialists.

“Anecdotally, I have heard that the reason [dentists] are signing up is there’s a concern that their existing patients … may change to another office, because they would like the government to pay for what they are currently paying for themselves,” Antel said.

WATCH: Health minister defends communications on dental plan

Health minister defends communication on dental plan

4 hours ago

Duration 2:21

A report by the Canadian Dental Association is calling on the federal government to clear up misconceptions about the federal dental care plan. Health Minister Mark Holland says dental offices that opted into the program aren’t experiencing these concerns and encouraged those that haven’t signed on to join the program.

The Canadian Dental Association recently launched a campaign called “Know Before You Go” to try to counter some of the misconceptions it says dentists are encountering in their clinics.

“People are coming in expecting that they walk into a dental office, they get whatever they need and it doesn’t cost them anything. And we’re the ones that have to tell them that that isn’t the case,” Antel said.

Holland acknowledged the program is not free, as dentists are allowed to charge their patients the difference between what Ottawa pays and their own fees. There is also a co-pay, meaning patients with household incomes between $70,000 and $90,000 are only partially covered by the federal plan.

“Folks should have a conversation with their provider, and they should expect that in many instances there will be some fees,” Holland said.

The Canadian Dental Care Plan first started covering seniors in May of this year. So far, 250,000 seniors have received care, officials said today. On June 27, the program expanded to include children under 18 years of age and adults who receive the disability tax credit.

Health Canada officials said Monday that they’ve received nearly 10,000 applications for people with disabilities and 25,000 for children.

It can take up to three months to be approved, officials said, and applicants won’t be covered for dental treatment until they’ve received their insurance information.


Do you have questions about how Canada’s new dental care plan may affect you? Send an email to ask@cbc.ca.