The contentious relationship between dentists and payers caused by low reimbursement rates and case denials has sparked reform initiatives nationwide.
Here are three ways the dental industry is seeing headway in its quest for change.
Medical loss ratios for dental payers
In December, Massachusetts created a law establishing a medical loss ratio that would require dental insurers to spend a minimum of 83 percent of premium dollars on dental services or refund the difference to patients. The law takes effect Jan. 1.
Other states such as Connecticut, Nevada and Oklahoma have followed Massachusetts' lead by pursuing medical loss ratio legislation of their own.
"One of the biggest challenges is working with insurance companies due to the rising input costs hitting dental offices such as labor shortages and wage and supply inflation," Michael Schwartz, chair and CEO of Specialty Dental Brands, told Becker's. "Every dental office in the U.S. has seen these expenses dramatically increase, yet the average dental insurance company provides fee increases of 3 percent if you are lucky every two to five years. This dynamic is completely out of balance. The legislation passed in Massachusetts is the first step in addressing this problem."
Increased payer accountability
Illinois and California introduced bills to increase accountability for dental payers.
Illinois' three-bill package aims to require dental insurance carriers to spend at least 80 percent of premium dollars on patient care, increase dental plan transparency when leasing to dental networks, and ban virtual credit card fees.
California proposed two bills — one to close loopholes that deny patients coverage and lead to increased out-of-pocket costs, and another that would require dental insurance plans to disclose whether the enrollee's plan is subject to state or federal regulations at the time the provider is ascertaining a patient's eligibility and benefit determination.
Increased Medicaid reimbursements and coverage for dental services
Though overall reimbursement rates seem unlikely to rise anytime soon, there has been progress regarding increased Medicaid reimbursements and coverage for dental services.
As part of its finalized 2023 Physician Fee Schedule, CMS expanded the dental services it will cover. Beginning in 2024, CMS will pay for dental exams and other essential treatments prior to the treatment of head and neck cancers. CMS will also clarify and codify parts of the current Medicare fee-for-services payment policies for dental services that are essential to a patient's primary medical condition treatment.
Michigan raised its reimbursement rates for dental procedures performed in outpatient hospitals and ambulatory surgery centers Oct. 1. The minimum Medicaid payment rates for dental services provided under general anesthesia at outpatient hospitals were raised to $2,300, and to $1,495 for services provided at ASCs.
Nebraska legislators are considering a bill to increase reimbursement rates for Medicaid dental services by 25 percent in an effort to improve access to dental services for state Medicaid recipients.