Washington State Dental Association campaigns for dental insurance reform

State bills seek to prioritize patient choice, stop deceptive practices

The Washington State Dental Association is campaigning for dental insurance reform in support of state bills that aim to prohibit unfair and deceptive practices by dental insurance companies and prioritize patient choice.

State Senate Bill 5351 and House Bill 1535 seek to align dental insurance protections with medical insurance protections, ensuring that patients can choose their dentists and receive full benefits without corporate restrictions. Key provisions in the bills include mandating that a certain amount of premium dollars be spent directly on care, allowing patients to request independent reviews of denied claims, and addressing various inequities in system.  Both versions of the bill have been heard by policy committees in their respective chambers.

The Washington State Dental Association’s Fix Dental Benefits Campaign “support[s] this common-sense legislation that would put dental patients over profits.” The organization has run digital advertising in a number of markets around the state and launched a website that provides education about dental equity in Washington state and the importance of dental insurance reform. 

Chris Dorow, D.D.S., president of the Washington State Dental Association, said current dental insurance company practices restrict access to care and increase patients’ out-of-pocket expenses. 

“[This legislation] will restore equity to the dental insurance market, improve access to oral health care in our state and put patients — rather than insurance company profits — back at the center of the system,” Dr. Dorow said. 

Chief among the association’s concerns: the anti-competitive practices leveraged by the state’s largest dental benefits provider, Delta Dental of Washington. The insurer controls up to 90% of some dental benefits markets in the state. 

According to the Washington State Dental Association, Delta Dental uses its dominance to bully patients into staying in-network. When patients choose an out-of-network dentist, Delta reimburses significantly less — sometimes less than half what they pay for in-network care even though they collect the same premiums. Other Delta Dental organizations do not engage in such aggressive pricing schemes elsewhere in the U.S., the association said, nor do the insurer’s in-state competitors. 

Lisa Egbert, D.D.S., president-elect of the Washington State Dental Association, emphasized that for many patient cases there are practical and medical reasons to treat the entire mouth in one appointment. But some companies, such as Delta Dental of Washington, will often only pay for treatment of half the mouth in one appointment. 

“Based on my experience and consultation with periodontists, there is no medical justification for this restriction. It simply allows them to delay payout for claims, and they can hold onto patients’ premiums dollars longer,” she said. “Not all insurance companies have this restriction, But the biggest one does, and that affects thousands of patients.”

Through its online campaign, the Washington State Dental Association hopes to educate patients and providers on why the state needs new dental benefit laws that serve both patients and the professionals who care for them. 

Kevin Schilling, the association’s advocacy director, said the association is prepared to continue working with the Office of the Insurance Commissioner on refinements to the bill’s language.  

“We know that changes must be made to stop predatory, uncompetitive actions in the marketplace. This bill will do that, and will provide huge benefits for dental patients all across the state,” he said.