Dr. Matthew Cohlmia
Patients who pay monthly premiums for dental insurance expect that insurance to pay for their dental care. Unfortunately, I have seen that this is not always the case, causing major problems for patients. The Oklahoma Legislature can provide the solution by requiring that at least 85% of patients’ dental insurance premium dollars are spent on patient dental care.
I seem to have this discussion far too often with many patients. Once treatment options have been viewed and determined for the patient’s best interest, the same concern is brought up by them, “I just don’t understand why my insurance pays so little for my treatment, yet I regularly pay a high monthly premium for my dental coverage.” It is a very difficult discussion for not only the patient but for the provider, as well. All this money spent for dental coverage, yet very little is paid by the insurance company toward their treatment. This situation, unfortunately, leads to delayed treatment or sometimes no treatment at all.
This problem isn’t unique to Oklahoma. Nearly half of American adults say they find it difficult to afford health care costs. They also say they are more likely to put off oral health care than any other type of care. When patients can’t get the dental treatments they need, oral health problems can get much worse, leading to more extensive and expensive treatment down the road. Research also has shown that poor dental health is linked to conditions such as strokes and academic and employment challenges. I see these real-life consequences in my practice.
According to available data, a quarter of dental premiums are currently being spent by insurance companies on things like executive salaries, administration, and boosting profits. Some insurers spend far more. Every dollar insurers avoid spending on patient care can be applied to these other costs, which do not benefit patients. While highly paid executives and shareholders reap the benefits, patients pay the price.
The Oklahoma Legislature can help protect dental patients by requiring that dental insurers spend at least 85% of the premiums they collect on patient care. If insurers don’t meet this standard, they must refund the difference to patients or, if an employer is paying the premiums, to the employer. A Medical Loss Ratio law would increase transparency in dental insurance and help hold down both premiums and out-of-pocket costs for patients. This is also a tried-and-true strategy. Health insurance carriers in Oklahoma already are required to spend 80-85% of premiums on patient care. Currently, Oklahoma has no such standard for dental insurance.
We can expect dental insurers to say this is an unreasonable standard that will force them to stop selling insurance in Oklahoma. This is simply untrue. Health insurers remain profitable under similar standards, and have continued to increase their net income and shareholder dividends. Also, many dental insurers already meet or exceed the 85% standard. But with no transparency and no minimum standard, some fall short. We need a law to ensure all patients get good value for the premiums they pay.
Dental patients know their dental insurance isn’t serving them well. That is why 72% of Massachusetts voters from across the political spectrum voted to adopt Medical Loss Ratio for dental insurance in November. Oklahoma patients deserve the same protections.
Our lawmakers have the power to make it happen, and they should do so without delay when the new legislative session begins Feb. 6.
Dr. Matthew Cohlmia is a dentist in Oklahoma City.
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