Ottawa got to root of problem on dental plan: Manitoba dentists

The Manitoba Dental Association is praising the federal government’s decision to amend the delivery of Canada’s national dental plan after previously panning it for being too restrictive.

The Liberals announced Monday dentists, dental hygienists, denturists and dental specialists will not be required to register for the Canadian Dental Care Plan before treating patients. Instead, the program will be delivered on a claim-by-claim basis, allowing providers to bill the insurance company directly.

Manitoba Dental Association president Daron Baxter said this process “more closely resembles” how dentists and oral health-care providers currently handle insurance claims.

“The (plan) is a historic opportunity to expand access to care for patients who didn’t have access to dental benefits previously, but we want to make sure the foundational design is sustainable in the long term,” Baxter said by phone.

While the move is a step in the right direction, some administrative tools provided by Sun Life Financial to help dentists determine their patients’ coverage and eligibility are only offered to registered providers — creating an unnecessary layer of red tape, she said.

Discussions about whether such tools will be offered to all dental professionals regardless of whether they’ve registered with the government are ongoing, she said.

“Ultimately, if the government creates hurdles for dentists using the claim-by-claim pathway and rewards dentists for using the registration pathway, then that pushes things in the direction of registration still and creates limitations or restrictions for patients,” Baxter said.

Rechie Valdez, the federal minister of small business, visited Winnipeg to announce the changes, which came after consultations with dental associations and industry leaders, she said.

“That was the feedback we received, and so we were able to implement that … because of that, I think we are going to have a lot more providers be able to support those in the community,” Valdez said.

Dental associations across the country previously panned the $13-billion plan for originally requiring providers to register for the program. Critics said that would force some patients to change their dentist, if that provider did not sign up.

The government said roughly 12,000 providers have registered to participate in the plan, which is being rolled out in stages.

It launched last December to seniors aged 87 and older. Eligibility later expanded to include seniors aged 65 and older, disabled adults and children under 18. The plan will continue to expand in 2025 to all Canadian residents who do not have dental benefits and have a household income of less than $90,000 a year.

Once it is fully implemented, an estimated nine million Canadians will be eligible for coverage, the government said.

“I think if you open the floodgates, it would be very difficult for providers to be able to keep up with the demand. I think what’s been important is we’ve done it in a slow, progressive way that will allow us to slowly integrate different groups of people … (and) work out the processes for dental care providers,” Valdez said.

Federal figures indicate 2.1 million seniors have been approved under the plan since its launch. Of those, nearly 250,000 have received coverage for oral health services, including cleanings, fillings and dentures.

An estimated 10,000 people with disabilities and 25,000 children have also applied for coverage, The Canadian Press reported.

Speaking to reporters in Nova Scotia, federal Health Minister Mark Holland stressed the plan is “not a free program” and some patients will be required to cover a portion of costs, depending on the dental service they receive.

The government has established reimbursement limits for a variety of services, including cleanings, fillings, X-rays and root canals. The amount covered by the government will vary depending on how much the service provider charges and the patient’s net income.

“We have a process that we’ve engaged in (with) Health Canada to determine what we think is fair and what we think we can cover,” Holland said.

Families with a net income less than $70,000 are covered at 100 per cent of established limits; families with a net income below $79,999 will be expected to pay 40 per cent; and families earning below $90,000 would pay 60 per cent.

“Folks should have a conversation with their provider and they should expect that in many instances there will be some fees … and that’s indicative of most insurance programs,” Holland said.

Providers must agree to bill Sun Life, which has been tasked with processing all claims.

The insurance company will receive reimbursement within 48 hours. The government expects to further reduce the reimbursement turnaround time to 24 hours, it said.

Health Canada did not respond to requests for comment.

tyler.searle@freepress.mb.ca