Half of requests for complex dental work are being rejected under national insurance plan

As federal dental care expands to cover most uninsured Canadians, providers say some procedures are being bogged down by paperwork and processing delays.

Health Canada says 52 per cent of requests for pre-authorized dental work between November 2024 and June 2025 have been rejected.

While the vast majority of claims don't need pre-authorization, it's required for more complex and often more expensive procedures, like crowns or partial dentures. Clinics must submit extra documentation like X-rays and dental charts to show the work is medically necessary before it can be covered and completed.

"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," said Dr. Bruce Ward, a Vancouver dentist and president of the Canadian Dental Association.

"It's a much, much, much higher rejection rate than private plans."

The multibillion-dollar Canadian Dental Care Plan helps cover the cost of dental work for Canadian residents with a family income below $90,000 who don't have access to private insurance. The program fully expanded to cover people aged 18 to 64 last month.

Health Canada says 5.2 million people have been approved for coverage so far, but only about half — 2.2 million — have received care.

And some new patients are getting an unexpected bill, while certain parts of the country are struggling to keep up with a huge influx of appointments, Ward said.

Still, providers told CBC News the program is providing Canadians much-needed access to care — and that issues with the program are improving.

Clinics submit the pre-authorizations through Sun Life, the insurance provider that the federal government contracted to run the program.

Dental offices are sometimes waiting weeks or months for a response, only to be told Sun Life needs additional documentation — further slowing down the process, Ward said.

"A lot of people have been waiting for crowns to be pre-authorized," Ward said. "There was an avalanche of approvals that got sent in."

Health Canada said rejections and delays in pre-authorizations are caused by several factors, including an unexpected high volume of submissions that were missing information.

Oral health-care providers also tell CBC News there were many technical issues with the submission software that have since been largely resolved.