Patients and dentists say unexplained rejections for crowns and dentures are undermining federal dental plan
Sun Life has denied pre-authorization requests for dental crowns and dentures under the Canadian Dental Care Plan without explanation, leaving patients, dentists and MPs demanding answers from the federal government.
CBC News reported that Walter Bossé, a retiree in Kirkland, Que., had his dentist submit full documentation, X-rays, and medical justification for two separate crown pre-authorizations.
Both were denied.
When he called Sun Life, he was told only that his claims were rejected "as per the plan criteria."
After escalating to a supervisor, he still received no specific reason.
The crown would have cost him just over $1,600.
His wife later pursued a crown replacement under the same plan; her pre-authorization was also denied without explanation, and she paid out of pocket.
NDP MP Jenny Kwan, who represents Vancouver East, told CBC News she has heard similar complaints from multiple constituents.
Her office intervened after one resident's denture pre-authorization was rejected.
Kwan said her father "literally couldn't eat" and that the family had to "fight tooth and nail" for partial coverage.
She sent an open letter to Health Minister Marjorie Michel this spring, calling it senseless that dentists following all the rules are still being rejected.
According to CBC News, the CDCP subsidises dental costs for Canadian residents with a household income below $90,000 who lack access to private insurance.
Basic procedures do not require pre-authorization, but more expensive ones such as crowns and partial dentures do.
Sun Life administers and processes all claims.
The Canadian Dental Association told CBC News that frequent denials were delaying timely care and creating an "administrative burden" for dentists.
Marie-Claude Desjardins, president of the Quebec Association of Dental Surgeons, said coverage for complex procedures remains opaque and called for the process to be "simpler, clearer and more predictable for both patients and dental teams."
Sun Life directed all questions about CDCP management to Health Canada.
In an emailed statement cited by CBC News, Health Canada spokesperson Karine LeBlanc said the most common denial reasons include incomplete submissions, insufficient evidence of clinical need, duplicate requests and requests for services not covered under the plan such as implants or bridges.
"The CDCP is not a free dental care plan," LeBlanc wrote, noting dentists sometimes charge above CDCP-established fees and that the remaining balance is the patient's responsibility.
CBC News reported that the program faced similar scrutiny when it expanded to adults aged 18 to 64 last year, with half of all requests for complex dental work turned down.
The Canadian Health Coalition reported that 6.4m Canadians have enrolled in the CDCP, short of the 9m originally projected.
The coalition attributed the gap to registration barriers, noting income thresholds have not risen with inflation since the program launched in 2022 and that mandatory annual re-enrolment creates additional opportunities for eligible Canadians to lose coverage.
Current members must renew by June 1 to remain covered, per CTV News.
Members must have filed a 2025 tax return, and those with spouses or common-law partners must ensure they have filed as well.
Those who miss the deadline will see coverage end June 30, with no retroactive reimbursement for care received during any gap, the federal government said.
Members can renew online through their My Service Canada Account, through Canada.ca or by phone through Service Canada.
