What the CDCP has to approve before we start

Most CDCP care needs no permission in advance: we examine, we treat, we bill Sun Life. A defined group of treatments is different. For those, the plan has to agree in advance, and the approval has to be in hand before the appointment — not afterwards.

Which treatments need approval?

Service Canada names five groups:

• Major restorative work — crowns, and the cores and posts that support them.
• Removable prosthodontics — partial dentures, complete immediate dentures, and overdentures.
• Endodontics — re-treatment of a root canal done previously.
• Periodontal work — bonding for loose teeth, and post-surgical evaluations.
• Sedation — conscious sedation, deeper sedation, and general anaesthetic.

Ordinary care sits outside this list. Exams, X-rays, cleanings and scaling, fillings, a first root canal treatment, extractions and complete dentures do not need pre-approval.

How does the process work?

We recommend the treatment, send the request with our findings, and wait for the plan to confirm coverage before we book you in. The plan weighs your oral health history and any medical conditions. We will tell you what we have asked for and what we are waiting on.

Is approval a formality?

No, and it would be unfair to suggest otherwise. Service Canada states directly that not all requests are approved. In our experience crowns are the clearest example: they are a covered service in principle, and approval still does not come as a matter of course.

What if the plan says no?

You can still go ahead and pay for the treatment yourself — a refusal is a coverage decision, not a clinical one. We will give you the cost in writing before you decide, and we will talk through the alternatives, including doing nothing for now where that is a reasonable option.

What should I do while I wait?

Keep the tooth clean and tell us if anything changes — pain, swelling, a piece breaking away. If a tooth becomes an emergency while a request is outstanding, call us; urgent care is covered and does not wait on a pre-approval.

The rest of the plan — who qualifies, what it pays, how co-payments work — is on our CDCP guide. If your coverage is close to its renewal date, read renewing your CDCP coverage first, because an approval is worth little if the coverage behind it has lapsed.

Source: Government of Canada — What is covered.