After months of probing, Walter Bossé is still trying to get to the bottom of why he doesn’t qualify to get a crown covered under the Canadian Dental Care Plan (CDCP).
The public insurance program subsidizes the cost of dental care for Canadian residents with a household income below $90,000, if they don't have access to a private insurance plan.
Insurance provider Sun Life administers the CDCP and processes claims.
While most claims don’t need pre-authorization, it’s required for more expensive procedures, like crowns or partial dentures.
In the last year, Bossé said he’s had multiple pre-authorization requests for crowns denied, even after his dentist submitted the proper documentation, X-rays and a detailed explanation to show why they're medically necessary.
“I was quite surprised because the dentist was convinced it was straightforward,” said Bossé, who lives in Kirkland, Que., a suburb of Montreal.
Bossé had a broken filling. Although his dentist repaired the base, the tooth needed a crown. A subsequent pre-approval request a few months later for a different tooth, which was cracked, was also denied.
Across the country in B.C, the NDP MP for Vancouver East has heard similar complaints from several of her constituents.
“They should not have to battle the insurance company to try and figure out what it is that they might be doing wrong,” said Jenny Kwan.
“For all we know, they might not be doing anything wrong.”
In one case, her office intervened after a resident’s pre-authorization request for dentures was rejected.
“He literally couldn’t eat,” said Kwan. “We had to fight tooth and nail to only get partial coverage.”
Other constituents in her riding were turned down for crowns. Kwan says neither her office nor the dentist clinics can “make heads or tails out of it.
