In a bid to improve dental care affordability and transparency, companion bills filed last week in Washington State Legislature are seeking to mandate clearer insurance practices and provide better coverage for dental patients. Senate Bill 5351 and House Bill 1535 aim to ensure that a larger portion of dental insurance premiums is directed toward patient care, promoting fairness and transparency in dental insurance plans.
Key Provisions of the Bills
The bills are championed by the Washington State Dental Association (WSDA), which represents over 4,000 member dentists. They propose a minimum “dental loss ratio” of 85%, meaning that at least 85% of the premiums collected by dental insurers must be spent directly on patient care. This ratio would help limit the percentage spent on administrative costs, executive compensation, and charitable work. Delta Dental of Washington, the state’s leading insurance provider, has been cited by WSDA as an example, despite claims that the company spends over 90% of premiums on patient care. The legislation aims to provide more financial transparency, particularly for smaller businesses that may experience lower rates of care.
Why This Legislation Is Needed
The need for these bills arises from concerns over how dental insurance companies allocate premiums. While major insurers like Delta Dental claim high payout rates, some smaller businesses offering dental plans for employees report lower reimbursement rates for patient care. The bills are also designed to increase consumer trust by giving patients more insight into what they can expect from their insurance, preventing any confusion about where their money is going.
Bracken Killpack, executive director for WSDA, highlighted that this legislation seeks to shield consumers from poor practices by insurance companies that may prioritize profits over patient care.
Addressing Split Procedures
A provision in both bills also aims to eliminate a common practice among insurers that requires certain dental procedures to be split into two visits—such as scaling and root planing, which is a deep cleaning process to remove plaque and tartar. Dental professionals argue that this practice unnecessarily prolongs treatment, leading to higher costs and inconvenience for patients, particularly those in rural areas or with dental anxiety. Dr. Brittany Dean, a pediatric dentist and WSDA board member, explained that it would be more medically effective and cost-efficient to perform such procedures in one visit rather than split them into multiple appointments.
By eliminating this requirement, the bills aim to streamline dental care and ensure that it is delivered more efficiently, reducing unnecessary delays in care that can have serious implications, such as delaying other medical procedures.
Parity in Reimbursement for Out-of-Network Providers
The third key provision of the bills focuses on ensuring fair reimbursement for dental providers who are not part of an insurance company’s network. Currently, WSDA claims that Delta Dental of Washington reimburses out-of-network providers up to 53% less than other insurance companies, making it difficult for rural providers and patients who prefer non-network dentists. This reimbursement discrepancy has been cited as a reason for fewer dentists in rural areas, as providers struggle to compete with in-network rates. This provision of the bill would help ensure that patients have greater access to the dental care they need, regardless of whether their dentist is in-network.
A Growing National Movement
Washington is not alone in addressing these issues. States like Massachusetts have recently passed similar laws mandating that insurance companies spend a certain percentage of premiums on patient care. Other states, both Democrat and Republican-led, are also considering similar legislation to promote transparency and protect patients’ interests.
With the support of at least 15 bipartisan sponsors, the companion bills will be heard in public hearings before the House Health Committee and Senate Health Committee next week. Both bills seek to make dental care more accessible, transparent, and fair for patients across Washington state, ensuring that patients can get the care they need without undue financial strain.
As Dr. Chris Dorow, WSDA’s board president, stated, “We have to protect the people. They are not getting the access to their benefits that they’re due.”
The WSDA and dental professionals hope that these legislative changes will bring more equitable access to dental care for all Washington residents, particularly those in rural communities, and eliminate administrative practices that hinder patient access to quality care.
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