Dental leaders and clinicians are pushing for increased oversight and accountability for dental insurance companies as challenges mount for practice operations and patient care.
Six updates:
1. The House Energy and Commerce Committee and the House Ways and Means Committee held a joint day of hearings Jan. 22 with CEOs of several large health insurance companies to focus on overall commercial availability of health insurance. The American Dental Association pushed lawmakers to use the hearings as an opportunity to advance dental insurance reforms to improve transparency, accountability and competition. Dental loss ratios, nonconsensual network expansion, rate leasing practices and claims administration standards were among the other reforms and fixes the ADA recommended.
2. New data from the ADA’s Health Policy Institute shows about 29% of dentists dropped insurance networks last year, and roughly 35% of dentists indicated they may drop insurance networks this year.
3. West Virginia Sen. Jason Barrett is expected to introduce a bill that includes a dental loss ratio. The More for Your Smile bill would require insurers to allocate at least 85% of premium dollars on patient care. If the bill becomes law, West Virginia would become the third state to enact a dental loss ratio requirement, following Massachusetts and North Dakota.
4. Delta Dental is facing a class-action lawsuit for allegedly misrepresenting its out-of-network coverage. The defendants listed include the Delta Dental Plans Association, Delta Dental Insurance Company, DeltaCare USA and more than 40 Delta Dental entities. The lawsuit accuses Delta Dental of breach of fiduciary duty and denial of benefits in violation of the Employee Retirement Income Security Act. It alleges that the insurance company misrepresents the percentage of out-of-network dental care it will cover, resulting in patients paying more out of pocket. It also claims Delta Dental refuses to disclose its reimbursement rates to insured individuals.
5. Dentists and clinical organizations have continued to voice their disapproval of Delta Dental of Wisconsin’s acquisition of Cherry Tree Dental. Delta Dental of Wisconsin announced in July that it purchased Cherry Tree Dental. Delta Dental has said Cherry Tree, which has locations in Wisconsin, Illinois, Michigan and Minnesota, will operate as a separate company and the two organizations will have separate leadership structures. Despite this, the acquisition has sparked concerns of conflicts of interest within the dental community, including from the ADA, the Wisconsin Dental Association, the American Economic Liberties Project and the Alliance of Independent Dentists.
6. Eighteen states passed a total of 37 dental insurance reform laws in 2025. The most common insurance issues addressed include dental loss ratios, virtual credit cards, assignment of benefits and improvements to provider credentialing processes. Overall, more than 120 legislative proposals were filed last year.
