Editorial: Give dental patients' coverage some teeth

By The Herald Editorial Board

Companion bills filed last week in the state Legislature aim to make dental bills and insurance coverage less of a pain than the average cavity filling.

Both bills — Senate Bill 5351 and House Bill 1535 — seek to bring to dental patients a standard of financial transparency and assurance similar to the federal Affordable Care Act, in effect, mandating that a certain percentage of what someone pays for their insurance is available for their dental care.

Both bills are promoted by the Washington State Dental Association, which represents more than 4,000 member dentists and advocates for patients' oral health care.

The legislation, among other provisions, would mandate that insurance providers in the state — Delta Dental of Washington being the leading dental insurance provider — assure that a minimum of 85 percent of premiums that an insurer collects — called a "dental loss ratio" — would be spent on patient care, said Bracken Killpack, executive director for WSDA, leaving up to 15 percent for the insurer's administrative costs, executive compensation and its charitable work.

Washington isn't the only state looking at setting a floor for the percentage of premiums used for patient care. Massachusetts voters recently passed with 70 percent approval a similar law that also sets an 85 percent rate for dental care. Likewise, Killpack said, other states, blue and red, are considering similar legislation.

The intent is to provide dental patients with some transparency as to what they expect from their insurance provider, but also so keep some of the national market's bad actors out of the state.

"The worst thing that could happen is to have someone put hard-earned money into what they think is dental care and have these plans that are not up to snuff and wonder where that money has gone to," Killpack said.

WSDA acknowledges that Delta Dental says it pays out more than 90 percent of the premiums it receives for patient care, but the dental association, citing federal Internal Revenue Service records, notes that's an average and doesn't address the lower rates for patient care spending that some small businesses that purchase plans for employees are seeing.

For comparison, Willamette Dental, a dental health maintenance organization in the state with practices in Everett and Mountlake Terrace, has consistently paid out more than 90 percent of its premiums received for patient care.

Another provision in the bills would also correct a long-standing practice mandated by insurance providers — for reasons that aren't clear — that requires providers to split a procedure into two visits, such as scaling and root planing, a deep cleaning that removes hardened plaque and tartar from above and below the gum line.

Dr. Brittany Dean, a pediatric dentist in Edmonds and a WSDA board member, said a colleague of hers who works with patients with dental anxiety and may have gone long periods without care often need this type of deep cleaning, but the insurance rules pay less for some of the procedure unless it's split into two visits.

"Somebody might be traveling from far away, they might have so much anxiety that they're taking a sedative medication to get through this appointment, and there's nothing medically that would limit them from being able to just get everything done at once," Dean said.

It's actually healthier to have the procedure done in one visit, she said, because splitting it into two visits can leave bacteria in the mouth until the next visit, giving it time to spread back to the treated area.

It's also a frustration for those in rural areas especially, said Dr. Chris Dorow, WSDA's board president and a a dentist in Othello.

"It's tragic because these folks can't get off of work to get in for multiple appointments. And it's hardship for them, and it hurts my community," he said.

Further, a delay in dental treatment can force other delays in medical care, Dean said, because some medical procedures can only go forward once dental treatment is complete. For example, someone with cancer and needing a stem cell transplant can't undergo that procedure until a dental infection has been treated, to prevent the infection from taking advantage of a suppressed immune system, she said.

Treatment scheduling, Dorow and Dean agreed, should be decided by patient and dentist, not by the insurance company.

A third provision in the bills is targeted at parity for reimbursement for dental providers not in an insurance company's network. WSDA maintains that Delta reimburses out-of-network providers at rates far below that of other insurance providers, doing so to maintain its network, which includes more than 90 percent of providers in some markets in the state.

While it's common to reimburse out-of-network providers at a lower rate, WSDA claims that some out-of-network dental providers receive up to 53 percent less from Delta Dental of Washington than other insurance companies for non-network providers for a typical appointment including cleaning, x-rays and exam.

"It's an incredibly anti-competitive practice," Killpack said. "If a patient wants to go to an out-of-network dentist, for whatever reasons, (Delta) will pay in many cases, less than half what they would pay in network," leaving patients to make up the difference.

The intent, Dorow said, is to maintain its network of dental providers through punitive measures and discourage dentists from leaving Delta.

"The result of that has been tragic in rural Eastern Washington, because it is so difficult to hire trained staff," Dorow said. "We can't compete because we are not as viable as we used to be."

Both bills, each of which have at least 15 bipartisan sponsors, are scheduled for public hearings before each chamber's health committees next week; the House bill on Tuesday and the Senate bill on Jan. 30.

'We have to protect the people," Dorow said. "They are not getting the access to their benefits that they're due."