Bill would ensure that more dental premium money is being spent on patient care

 

STATE HOUSE — Rep. Joseph M. McNamara and Sen. Hanna M. Gallo have introduced legislation to increase transparency in dental insurance and ensure that more of patients’ premiums are being spent on patient care.

The Fair Share for Dental Care bill would require dental insurers to spend at least 85% of customers’ premiums on patient care, or refund the difference to them.

“As the value of their dental plans diminishes, we’re seeing more and more patients forgo essential oral health treatment,” said Representative McNamara (D-Dist. 19, Warwick, Cranston). “By establishing the requirement that more premium dollars be spent for patient care, we will help reduce the out-of-pocket costs for patients, making dental care more affordable. This will encourage more Rhode Islanders to seek the dental care they need, while at the same time attract more oral health care providers to the state.”

McNamara said that a perfect storm is on the horizon, with a national dentist shortage coupled with a slew of retirements exacerbating an already-serious crisis.

“About 45 percent of Rhode Island’s dentists are 55 or older,” said McNamara. “Add that to poor reimbursement rates, and you’re going to see the ranks of dentists in this state rapidly diminish, with no replacements coming from out of state.”

Said Senator Gallo (D-Dist. 27, Cranston, West Warwick), “Quite simply, most of the money people pay for dental insurance premiums should be going toward actual dental services, not overhead and profit for insurers. Our bill helps create insurer transparency and accountability, and will keep insurers from inflating premiums by requiring them to refund excessive profits to patients. Ultimately, this bill will help make dental insurance more affordable and ensure that oral care providers are being paid rates that are competitive with surrounding states.”

Under the legislation (2024-H 7082), which Representative McNamara introduced Jan. 10 and Senator Gallo will submit soon, carriers offering dental benefit plans would be required to submit annual reports to the state Office of the Health Insurance Commissioner that include the current and projected medical loss ratio for claims for their plans. A medical loss ratio is the percent of premium dollars collected by an insurance company that are spent on actual patient care and not on administrative costs such as salaries and marketing.

If the insurer spent less than 85% of premiums on patient care, it would be required to issue credits or refunds for the excess to its customers that year.

A similar dental insurance reform measure was passed by Massachusetts voters in 2022, spurring advocates across the country to pursue legislation to institute a medical loss ratio for dental plans in their own states.

The legislation was introduced last year as well, when numerous dentists from around the state testified in favor of the legislation, as did the Rhode Island Dental Association.

Dentists who testified last year said the bill would provide financial transparency, that Rhode Island has a difficult time attracting oral health care providers when compared to neighboring states, that the bill would result in less money going to insurance corporations and more to patients for direct care, and that the bill would hold dental plans accountable for prioritizing patient treatment costs over profits.          

 

                              

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