The newest details of Ottawa’s proposed Canadian Dental Care Plan have dentists worried. They say the fees that the federal government is proposing to pay for their services are too low and the administrative burden too high.
On Feb. 8, Ottawa released a sample fee grid for dental fees that will be covered under the federal plan. The fees are lower than those set by provincial guidelines, which are treatment prices suggested by economists hired by each province or territory’s dental association, says Dr. Juli Waterbury, president of the Nova Scotia Dental Association.
“At the end of the day, we’re operating small hospitals… I fear that the fee grades they’ve come out with don’t respect [what] it’s costing dentists to provide this care to Canadians,” said Waterbury.
Dentists are also concerned the government is misinforming the public by saying those with a net family income under $70,000 will not pay for treatment. But if Ottawa’s coverage is lower than the bill, the patient pays the difference, says Dr. Paul Blanchard, executive director of the New Brunswick Dental Society.
“Every Canadian needs to know before they go to [the] dentist that they’re going to have some out-of-pocket expenses,” said Waterbury.
‘Always frustrated’
In March 2022, the NDP and Liberals announced a supply and confidence agreement where the NDP agreed to support the minority Liberals in return for the party introducing a federal dental plan, among other programs. In 2023, Ottawa announced a plan to cover dental costs for the one-third of Canadians without dental insurance who have an annual family net income under $90,000.
The newly released details show dentists will have to do extra work at the start of every appointment to ensure a patient is eligible.
Currently, most dental offices submit a claim to the insurance company on the patient’s behalf. The patient pays the cost of the treatment up front and waits to be reimbursed by their insurance. It is the patient’s responsibility to know what and how much their plan covers.
But under Ottawa’s dental program, dentists who have enrolled in the plan will have to check with Sun Life, the insurer, to see if the patient’s treatment will be covered each time a patient comes in.
“There’s three people in this room with you, except the third person isn’t really present. And you need to wait for them to give their opinion about” whether the patient’s treatment will be covered, said Blanchard.
While every eligible Canadian will have a card stating their eligibility, dentists will need to verify the card is current and that the patient has not reached their maximum for any given treatment.
For example, a patient will be allowed only one filling every 24 months under the plan. If the patient happens to get another cavity during that time, another filling would not be covered, says Waterbury.
Extra administrative paperwork will make it even more difficult for dental offices to function effectively, said Dr. Jenny Doerksen, president of the Alberta Dental Association.
“Most dental offices do have electronic systems that make it transparent and seamless for the patients, providers and other dental insurance companies,” said Doerksen. She and other dentists have advocated for Ottawa’s dental plan to operate the same way.
But the Canadian Dental Care Plan is modelled after the Non-Insured Health Benefits Program, a dental plan for First Nations and Inuit people. Dentists criticize this program for underpaying dentists, imposing a high administrative burden and taking too long to determine whether treatment is covered, says Dr. Robert Wolanski, president of the B.C. Dental Association.
“Many dentists don’t participate with this plan, and those that do are always frustrated,” he said.
Blanchard said this system places strain on First Nations and Inuit people because of the program’s “poor design.”
If a patient under the First Nations and Inuit insurance plan has an abscessed tooth, the dentist has to apply for approval of the treatment. This can take weeks, says Blanchard. Meanwhile, the patient will be sent home with antibiotics to wait for the response.
“Having to wait days or weeks to start treatment… that’s a long time,” said Waterbury. “We need Health Canada and we need Sunlife to assure us that the turnaround times for these pre-authorizations is going to be very efficient.”
Unmanageable demand
There is a risk many dentists will choose not to enrol in Ottawa’s dental plan, says Waterbury. This would be a problem, given that the Canadian Dental Care Plan is expected to serve nine million Canadians.
“It’s pretty scary,” said Waterbury.
Nova Scotia’s dental association expects 134,000 people will be eligible for the plan in 2024, and that number will increase to 260,000 by the end of 2025. That is 26 per cent of the province’s population.
“That’s unmanageable. We can’t meet that demand,” said Waterbury, who noted that dental clinics already have too few dental assistants and dental hygienists.
In December, the New Brunswick Dental Society surveyed its 364 members on their initial reactions to Ottawa’s dental plan. Of the nearly half who responded, only 11 per cent said they supported the plan, 48 per cent had no opinion and 41 per cent said they somewhat or strongly opposed the plan.
The respondents also said ease of administration and agreement with their provincial fee guide were key considerations for whether to enrol in the plan. Few said filling empty appointments was a motivation to join. Most clinics in New Brunswick are not accepting new patients which, in Blanchard’s view, indicates dental practices there are full.
Existing patients who qualify under the new dental plan might have to change dentists if their current one does not join the federal program, said Waterbury.
Many dentists are still waiting for more details before they decide to participate. Wolanski is advising dentists in British Columbia to wait until further details are published in June.
“A lot of dentists including myself are at pause,” said Doerksen. “We were asked to sign up for something [when we have] have no idea” what it entails.
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