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Liberal government hopes changes to dental care program will increase uptake

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Less than one year after federal Liberals announced a new dental care program to mixed reviews, the government is making changes in hopes to get more providers on board.

Since its launch, the federal government says the Canadian Dental Care Plan (CDCP) has seen 11,800 dental care providers sign up with Sun Life Financial to officially take part. To grow that number, Ottawa is now allowing providers to seek reimbursement from Sun Life on a claim-by-claim basis, dropping previous requirements to sign up for the program itself.

Speaking in Dartmouth today, Health Minister Mark Holland said the government heard from many dental professionals who wanted another way to participate given “bad experiences” with other programs in the past.

Speaking about the changes, Holland said he hopes the ability to take part in the program on a claim-by-claim basis will rapidly increase the number of dentists who accept CDCP patients.

“One of the things I hear is that, you know, they have been burned by other programs, that they didn't have positive experiences,” he said about why some dentists have been hesitant to sign up. “Making sure that they see and feel that this program is really listening to them and is responding to their needs and is there for them, is a fair partnership, is extremely important.”

Before today's change, clients seeking coverage under the plan could only seek treatment from participating dentists and other providers that were listed on the insurance company’s website. Officials speaking on background say they hope the change will make it easier for clients to see the dentist of their choice.

"There are providers, and we wanted to listen to them, who had concerns about the need to sign up formally to Sun Life but wanted to see CDCP clients," said one Health Canada official speaking on background during a technical briefing. "As of today, they can submit a claim and it will be processed by Sun Life."

The first phase of the $13 billion program launched May 1 to service seniors 70 and over. Since then, Health Canada says more than two million eligible individuals have been approved for coverage and nearly 250,000 seniors have received treatment.

Eligibility has now expanded to accept applications from seniors 65 and over, adults with a valid Disability Tax Credit (DTC) certificate and children under 18. Health Canada says that just under 10,000 applications have been received for people with a valid DTC and just under 25,000 applications have been received for children under the age of 18.

Ottawa has said eligibility will expand further in 2025.

Dentists, denturists, dental hygienists and dental specialists have largely gotten behind the publicly funded dental insurance program, but some did have concerns about eligibility, as well as the billing agreement with Sun Life.

What is covered?

The CDCP covers a wide range of oral health care services including regular cleanings, root canal treatments, fillings and diagnostic services such as X-rays. The amount paid for by the federal program depends on your adjusted family net income and how much the provider charges.

Individuals with an adjusted family net income lower than $70,000 will have 100 per cent of eligible oral health care service costs will be covered at the CDCP established fees. That proportion of eligible oral health service costs covered drops to 40 per cent for individuals with adjusted family net incomes between $80,000 and $89,999.

Health Canada officials speaking on background reiterated that clients may have to pay out of pocket if they choose to receive services that are not covered by the federal program, or if they choose to see a provider that charges more than what the program covers.

Health Canada officials say all providers, whether they have signed up to the program or not, will now be able to submit a claim to Sun Life, receive an estimate about how much the client will be reimbursed and seek reimbursement on a claim-by-claim basis.

Health Canada officials say they are tracking the variances between what CDCP covers, what is being charged by providers and how much clients are having to pay out of pocket.

The Canadian Dental Association (CDA), which has had concerns with the program since the start, says today’s announcement isn’t much of a change. CDA president Dr. Joel Antel says dentists submitting a single claim are still required to sign on to what he calls a complicated set of terms and conditions, and are still required to essentially enter into a contract with the government, not the patient.

“If I have a patient at my office who is covered by conventional insurance I have a contract with that patient, and they have a contract with the insurance company who will pay part or some of their costs,” Antel said. “With this program my contract would be with the government, not the patient, and then I’ve got to figure out how to fit what the government wants the coverage to be to what the patient needs to what the costs to providing that care are.”

Antel says that to get more dentists on board the government should do what traditional insurance does, and recognize the provincial and territorial fee guides.

“The coverage in every province is less than what is traditionally charged to a patient who walks in with private insurance or no insurance,” he said.

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