Taking a bite out of CDCP: A step-by-step guide to converting CDCP patients.

The introduction of the Canada Dental Care Plan (CDCP) represents the largest single market shock in modern Canadian dental practice. It created, almost overnight, an entirely new segment of potential patients. Over five million Canadian residents are now approved and hold a Sun Life member card, officially granted access to care they previously could not afford. This is a massive, government-funded patient base.

Yet, as mid-2025 data confirms, a majority of these covered Canadians are not using their benefits. Enrollment surged, but utilization lagged. Only about 2.2 million people had actually received dental treatment by June, even while over 5.2 million were approved. The utilization rate currently sits below 45%. The federal government has delivered the funding and the patient access. The dental industry is failing to deliver the service.

The gap—the difference between 5.2 million covered lives and 2.2 million actual patients—is not a failure of demand. It is a failure of execution. It is the single greatest practice growth opportunity of the decade. The practices that capture this market will be those that move past the initial bureaucratic friction and convert a government policy into a disciplined operational playbook.

The Diagnosis: Friction Is the Barrier

The CDCP was designed to help Canadians who had avoided the dentist for years due to cost. Many of these newly eligible patients present with complex, deferred needs. They require comprehensive treatment planning, not just maintenance. This fact collides immediately with the program’s complex administration.

The primary barrier is high claim friction, felt most acutely in the pre-authorization process. For services beyond basic maintenance, providers must submit detailed documentation, including X-rays and comprehensive patient charts, for approval. In the first half of 2025, over half—roughly 52%—of pre-authorization requests submitted for advanced treatments were reportedly denied.

This high rejection rate is not a sign of government thrift. It signals a major disconnect in documentation and process. Dentists are submitting documentation that satisfies private insurers but fails to meet the unique, often opaque requirements of the new public administrator. When practices face long delays and high denial rates, they pull back. This hesitation transmits instantly to the patient, reinforcing their original fear: dental care is too complicated or too expensive.

We sat down with 10 dental practices. Here’s their EXACT plan on how they’ve planned around CDCP patients (note: this is an amalgamation of their strategies, not a consensus).

Phase 1: The Internal Audit and Segmentation

The immediate solution begins not with new patient acquisition, but with your existing database. Do your research on your current roster.

Every Canadian dental office has a dormant segment of patients: individuals who have declined necessary restorative work for years, citing financial constraints. Now, many of those existing patients—particularly seniors and those in the new low-to-middle income bands—are CDCP-eligible. Their coverage is a fundamental financial change, and it demands a fresh conversation.

Actionable Step: Segment your patient management software (PMS). Identify all patients aged 65 and over, all patients flagged with chronic treatment refusal due to cost, and all patients residing in specific socio-economic zones. Proactively contact this segment. Do not wait for them to ask about their new card. The message is simple: “We understand your financial reality has changed. You have insurance now. Let us review your previously recommended care under your new coverage.” This approach recaptures lost revenue with zero marketing spend.

Phase 2: Administrative De-Friction

The only way to overcome a 52% rejection rate is to standardize your documentation and assign a clear owner. For BC offices, new bills are aimed at helping minimize this rejection rate, but offices we’ve talked to so far aren’t really seeing this in practice. So, it’s good for everyone to take these steps.

Designate one senior administrative team member as the CDCP Compliance Lead (DA, receptionists, your call). This person’s sole responsibility is mastering the pre-authorization process. They must be fluent in the CDCP fee guides and understand the required charting detail. They should not rely on the expectation of private insurance norms. They must specifically train the clinical team on how complex cases must be documented to satisfy the public administrator’s criteria.

This lead should audit every rejected pre-authorization request. Identify the patterns. Is the narrative insufficient? Are the provided clinical photographs or radiographs failing to meet required resolution? The goal is to build an internal standard operating procedure (SOP) that targets a 90% authorization approval rate.

The claim submission method matters. Sun Life accepts both Electronic Data Interchange (EDI) and paper claims. If your team is struggling with the new EDI codes, they should default to the paper submission method to ensure no missing signatures or critical data points lead to automatic rejection. Compliance must override speed until the internal SOP is proven robust.

Phase 3: Mastering the Co-Pay Conversation

A significant source of patient confusion, and practice anxiety, is the co-payment structure. Many new patients assume the CDCP means free dental care. It does not.

Practices must be transparent about the three income tiers: 0% co-pay for families below $70,000, 40% co-pay for the $70,000 to $79,999 bracket, and 60% co-pay for the $80,000 to $89,999 bracket.

This requires a delicate, unsentimental financial discussion at the time of booking. The conversation should not position the co-pay as a barrier. It should position the CDCP benefit as a financial tool that makes comprehensive care possible. For a patient in the 40% tier, the conversation is: “Under this plan, the government is covering 60% of this necessary treatment. We will handle the paperwork. Your investment is only the remaining 40%. We can begin today.”

The practice that adopts this structured, segmented approach will stop viewing the CDCP as an administrative headache. They will begin seeing it for what it is: a subsidized, multi-million-patient market that rewards operational precision. The low utilization rate is a window of opportunity. It will not last. Do your research, optimize your internal machine, and capture your market share.