Dental Premiums Should be Spent on Patient Dental Care

By: Dr. Lindsay Smith, ODA Trustee, ODA Council on Governmental Affairs Chair, and owner of a private practice in Tulsa

It seems intuitive that dental insurers would spend the money they collect in premiums on patient dental care. However, that is not always the case. Oklahoma lawmakers can — and should — fix this problem in the new legislative session. Lawmakers can protect Oklahoma dental patients by passing legislation requiring that dental insurers spend at least 85% of patient premiums on patient care or refund the difference to patients. This law, known as Medical Loss Ratio, would increase transparency in dental insurance and help hold down both premiums and out-of-pocket costs for patients. Health insurance carriers in Oklahoma are already required to spend 80-85% of premiums on patient care, but there is no such standard for dental insurance.

Nearly half of American adults say it’s difficult to afford healthcare costs, and they are more likely to put off oral healthcare than any other type of care. As a dentist, I see this all the time, even with patients who have dental insurance. All too often I see patients postpone care altogether due to policy provisions within their dental plans. These include missing tooth clauses, waiting periods on major services, frequency limitations, and yearly maximums that in many cases have not changed since the 1980s. All of these "provisions" prohibit patients from receiving the care they need when they need it, causing more expensive and extensive treatment needs in the future. Requiring dental insurance companies to adhere to a medical loss ratio standard, just as health insurance companies in Oklahoma have already and have for several years, will allow patients to utilize their dental benefits they have worked so hard to acquire. There are many ways to make dental insurance work better for patients, so they do not delay or avoid needed care. Simply requiring dental insurers to spend the money they collect in premiums on patient care may be one of the most powerful. Available data indicates that around 25% of dental premium dollars are used by insurance companies to cover administrative costs, profits, and executive compensation, instead of being directed to patient care. When every dollar that is shifted away from providing care ends up boosting dental insurers’ profits, they have a powerful incentive to spend as little as possible on patient care. A law requiring them to spend at least 85% of premium dollars on patient care will lessen the incentive to deny paying for needed care. Dental insurers will claim that they cannot possibly meet this standard and that as a result, they will be forced to leave the state. Oklahomans should not be fooled by this argument. Health insurers have remained profitable under similar standards, and they continue to increase their net income and dividends paid to shareholders. In addition, many dental insurers already meet or exceed this standard. We need a law to bring the others in line. Skipping dental care can have serious consequences, not just for oral health but for overall health and wellbeing, with poor oral health linked to conditions such as strokes as well as poorer academic and employment outcomes. To avoid these outcomes, we must minimize cost barriers between patients and care.

Patients already know their dental insurance isn’t serving them well, which is why a bipartisan 72% of Massachusetts voters elected to adopt this policy in November. Oklahoma dental patients deserve the same protections. Our lawmakers have the power to make it happen, and they should do so without delay.

© Copyright 2023 Tulsa World, 315 S. Boulder Ave. Tulsa, OK 74103 This Op-Ed was published January 5th online in the Tulsa World and printed in the January 8th paper.

MAXIMIZING DENTAL BENEFITS FOR PATIENTS

Patient dollars should go to patient care, not to the profits of big dental insurance companies and their executives. For too long, multibillion-dollar dental insurance companies have lined their own pockets by taking advantage of patient premium dollars.

What is MLR?

The portion of insurance premium revenue that is spent on patient care rather than overhead is called the “Medical Loss Ratio ” or MLR. All states have a minimum ratio for medical insurance but very few have a similar standard for dental insurance plans.

How does this affect my patients/practice?

(MLR) ensures a healthcare insurance company to spend a minimum percentage of patient premiums on claims, patient care, and healthcare quality for its customers. Available data indicates that between 25-40% of dental premium dollars are used by insurance companies to cover administrative costs, profits, and executive compensation, instead of being directed toward patient care. While medical insurance carriers in Oklahoma are required to spend at least 80-85% of patient premiums on healthcare, there is no equivalent standard for dental insurance. We want to change that with MLR legislation in 2023.

MLR Legislation in 2023

MLR legislation introduced this year will require dental insurance carriers in Oklahoma to spend at least 85% of premium dollars on patient care rather than on administrative costs, salaries, and profits.

MLR legislation will require dental insurance carriers in Oklahoma to spend at least 85% of premium dollars on patient care rather than on administrative costs, salaries, and profits. If dental insurance companies spend less than 85% of patient premiums on actual dental care, they must refund the difference to covered individuals and groups. Setting a standard for Medical Loss Ratio means better dental benefits for patients. It means more families will be empowered to seek the dental care they need. MLR will increase transparency and accountability in dental insurance by requiring insurance carriers to disclose administrative costs and other financial information annually. Ensuring transparency and value in dental insurance rates will help reduce out-of-pocket costs for dental patients, which will make access to dental care and procedures more affordable and encourage people who wouldn’t normally go to the dentist to get dental care.

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