OPINION: Imperial County’s dental care gap goes beyond insurance coverage

A dental insurance card cannot chew dinner, ease a toothache, or get a child into an examination chair. Its value depends on whether someone can actually use it.

That should be Imperial County's standard for judging California's new dental insurance law: not whether the paperwork improves, but whether patients can get treatment without having to pay the entire bill upfront and wait for reimbursement.

Beginning Jan. 1, 2027, Assembly Bill 1629 will require state-regulated dental plans and insurers to pay qualifying out-of-network dentists directly when patients sign an assignment of benefits. This allows patients to authorize their insurer to send payment directly to the dentist rather than requiring them to pay the full treatment cost first and seek reimbursement themselves. The law also requires clearer disclosures about out-of-network status and patients' expected financial responsibility.

These are meaningful changes. But California should not mistake a better payment process for a solution to the larger problem of access to dental care.

For a household in El Centro, Brawley, or Calexico, the important questions are straightforward: Is a dentist available? Does that office accept the patient's insurance? What will treatment cost? How soon can an appointment be scheduled?

An insurance policy that cannot answer those questions clearly is selling uncertainty along with coverage.

Consider a patient whose plan covers part of a procedure but whose dentist requires full payment before submitting a claim. The insurer may eventually reimburse its share. That does little good if the patient cannot afford to advance the money today. Coverage that depends on a patient having enough cash to wait for reimbursement is of limited practical value.

AB 1629 addresses part of that problem, but its limits deserve equal attention. Direct payment does not turn an out-of-network dentist into an in-network provider. It does not eliminate deductibles, coverage limits, or the patient's remaining financial responsibility. The arrangement also requires the patient's signed consent, and the dentist must disclose the expected treatment cost and estimated patient share before accepting the assignment of benefits.

The law does not apply to Medi-Cal managed care plan contracts, including dental managed care contracts. Patients should understand which type of coverage they have and what protections apply before beginning treatment.

But affordability is only one side of the access problem. Imperial County also faces questions about the availability of dental professionals, particularly specialists.

A 2019 Imperial County Oral Health Community Assessment identified a shortage of local specialists, including pediatric dentists. Based on responses from local dental practices, the assessment found that dentists referred patients outside the county for specialized treatment. Sixty-eight percent reported referring patients to San Diego, 58% to Indio, and 37% to Yuma. These figures reflect the practices surveyed at the time, rather than a current count of referrals, but they illustrate a persistent challenge: having dental coverage does not guarantee that the care a patient needs is available nearby.

That distinction should guide how California evaluates dental insurance networks. A name in a provider directory is not an appointment.

State regulators should examine whether listed dentists actually accept the specific plans they are associated with, whether they are accepting new patients, and how long patients must wait for treatment. AB 1629 requires insurers and plans to certify the accuracy of network adequacy information submitted to regulators, including accounting for the total number of people relying on shared provider networks. Regulators can audit that information. The next step is ensuring that oversight translates into meaningful access for communities such as Imperial County.

Local employers purchasing dental benefits should demand answers, too. A low premium is no bargain if employees cannot find a participating dentist or must travel outside their community for necessary treatment. Before renewing a plan, employers should ask insurers to demonstrate that their networks provide realistic access in the communities where their workers live.

Dental practices have responsibilities as well. They should keep participation information current, explain expected charges before treatment, and clearly tell patients whether direct insurance payment is available.

None of these expectations is extravagant. They are basic requirements of a product sold as health coverage.

Imperial County should welcome AB 1629 without lowering the bar for success. The test is not how many insurance cards sit in residents' wallets. It is whether those residents can move from a phone call to an appointment, receive the treatment they need, and afford the cost.

Until that happens, California may have improved the rules, but it has not solved the problem.

Dr. Paula Izvernari is a Montclair, California dentist who believes access to quality dental care should be practical and affordable. She advocates for patient-centered care and greater access to the dental services communities need.

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