What to Do If Your CDCP Coverage Doesn’t Include Your Treatment

Check for Preauthorization Requirements

Some treatments may still be eligible for coverage under the CDCP but require preauthorization. This means that while the treatment is not automatically covered, your dentist can submit a request on your behalf to the plan administrator for approval before the treatment begins. If your dental treatment isn’t covered immediately, it’s worth speaking with your dentist about the possibility of preauthorization. This process typically involves your dentist submitting diagnostic details and a justification for why the treatment is necessary. Once approved, the CDCP can provide coverage for treatments that initially seemed ineligible. Make sure that you provide all the required documents to help expedite the process.

Explore Payment Plans with Your Dentist

If preauthorization isn’t an option, another approach is to look into payment plans offered by your dental office. Many dental clinics working with CDCP patients understand the financial constraints and often provide flexible payment options. These payment plans can spread the cost of expensive treatments over several months, making it more affordable to complete necessary procedures. You can access the treatment without worrying about paying the full cost upfront by breaking up the total expense into smaller, more manageable payments. Talk with your dentist or the office manager about the available payment plans and how they can be tailored to your financial situation.

Consider Dental Financing Options

Another way to manage the costs of treatments not covered by the CDCP is to consider third-party dental financing options. Dental financing companies offer plans specifically designed for medical and dental treatments, allowing patients to borrow the funds needed to cover the procedures. These services function similarly to personal loans or credit options but are tailored for healthcare costs, often with flexible repayment terms. Once the treatment is completed, you can pay it off over time through affordable monthly installments. Many dental offices have partnerships with financing companies, so ask your provider if they can assist you with finding a suitable financing option. This can be particularly useful for high-cost treatments like crowns, bridges, or implants.

Look for Provincial or Territorial Assistance Programs

If the CDCP doesn’t cover your treatment, you may also want to look into any provincial or territorial assistance programs that could provide additional support. Many provinces in Canada offer supplementary dental programs that can bridge the gap in coverage for specific populations, such as low-income individuals, seniors, or people with disabilities. For example, in Ontario, public programs are designed to help low-income seniors with dental needs, including dentures and extractions. Research what assistance is available in your province or territory and check whether you qualify for any of these programs. These government programs often work in tandem with federal initiatives like the CDCP to ensure Canadians have access to necessary dental care.

Check for Government-Supported Dental Clinics

Another valuable resource for patients whose treatments aren’t covered by the CDCP is government-supported or community-based dental clinics. These clinics are often designed to provide low-cost or even free dental services to individuals who cannot afford private care. Clinics like these may offer treatments such as fillings, extractions, and even prosthetic services at significantly reduced rates. Many of these programs work on a sliding scale based on income, making them an excellent option if you face significant out-of-pocket expenses. Additionally, charitable dental programs often provide free care during specific events or offer ongoing discounted services for underserved populations.

Consider Alternative Treatments

If the CDCP doesn’t cover your treatment, discussing alternative treatment options with your dentist is worth discussing. In some cases, different procedures or less expensive solutions can provide similar results while still falling within CDCP coverage. For instance, instead of opting for more expensive procedures like dental implants, your dentist might recommend partial dentures or bridges, which are often more affordable and potentially covered under the CDCP. These alternatives might not be the perfect solution, but they can help address your dental needs while reducing costs. Be sure to ask your dentist about all the available options and weigh the benefits of each.

Submit an Appeal

If a treatment request is denied under the CDCP, you still have the option to submit an appeal. Sometimes, additional documentation from your dentist, such as X-rays, medical reports, or treatment plans, can help demonstrate the procedure’s necessity and lead to reconsideration. The appeal process involves your dentist providing supporting evidence to the CDCP administrator and making the case for why the treatment should be covered. Work closely with your dentist’s office to gather all necessary documentation and follow up regularly on the appeal status to ensure the request is processed promptly. While not every appeal results in approval, many cases are reconsidered with the right information. Our office is ready to help you with an appeal to help get the coverage you need.

Talk to a Dental Social Worker

In some cases, dental clinics or community-based programs have access to dental social workers who can help patients navigate financial and coverage challenges. If you’re struggling to find coverage for a specific treatment, a dental social worker can assist in locating additional resources or programs that could help cover the costs. They may also be able to provide referrals to charitable organizations or help with the application process for provincial programs. Suppose your dental clinic has a social worker on staff. In that case, setting up a meeting to explore what financial assistance options are available for your specific situation can be helpful.

Look for Charitable Dental Programs

Several charitable organizations across Canada offer free or reduced-cost dental services for patients who don’t have insurance or who need assistance with uncovered treatments. Programs like Free Dentistry Days provide comprehensive dental care, including extractions, fillings, and even more advanced procedures, at no cost or a reduced rate. These organizations often rely on volunteer dentists and occur at specific times during the year, so staying informed about when these services are available in your community is important. Check local listings or dental associations for more information on how to access these charitable resources.

Stay Up-to-Date with CDCP Changes

Finally, staying informed about any updates or changes to the Canadian Dental Care Plan is essential. The CDCP is still evolving, and as the program grows, new treatments may be added to its list of covered services. Keeping up-to-date with any policy changes ensures that you don’t miss out on new opportunities for coverage. You can subscribe to government newsletters and dental associations or even ask your dental office to notify you of any relevant updates. Many dental practices that work with CDCP patients stay informed on the latest developments and can provide valuable guidance on new coverage options.

Martindale Dental Can Help Get You Dental Care

Our team put our patient’s oral health at the top of our list of priorities. We can help patients get the treatment they need through the CDCP, navigate any CDCP issues in getting coverage and offer payment plans or financing options through our own clinics.

If you have any questions or concerns or need help navigating our CDCP coverage, please don’t hesitate to contact our office.