Effort to Force Transparency and Spending Minimums on Dental Insurers Stalls in the Legislature


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HARTFORD – A bill to force insurers to spend more money on patient care for customers who purchase dental insurance has stalled in the legislature. That has dentists and their advocates questioning the holdup and insurance companies warning the legislation would lead to higher premiums. 

Under the Affordable Care Act, health insurers are already required to spend at least 80 to 85 percent of premium dollars on medical care. The companies are also required to disclose to the public how much is spent on administrative overhead. 

If passed, HB 5813 would require the same of insurers of dental care.

But before the bill, which was introduced into the Insurance and Real Estate Committee on Jan. 18, can head to a vote, it needs a public hearing.

“It’s consistently being denied. It really raises a lot of questions about where the block is coming from,” said Kathlene Gerrity, executive director of the Connecticut State Dental Association, in a call to CT Examiner. 

Gerrity said that if 85 percent of premium dollars were spent on dental care, the bill would bring more patients to dentists, and lower costs for consumers. She said dental insurance providers have not publicly opposed the bill.

But Mike Adelberg, who heads the National Association of Dental Plans, a trade organization representing the dental benefits companies, questioned the benefit of the bill.

“It’s not clear to me how a [medical loss ratio] necessitates lower cost sharing for the consumer,” Adelberg said. “An actuary or someone who works in insurance design would need to show me how that would happen.”

Adelberg also stressed the importance of certain administrative costs and their benefit to dentists and patients.

“A lot of administrative costs goes to services that legislators would support, including operating call centers, maintaining broad provider network, adjudicating claims and detecting fraud, waste and abuse,” he said.

But while Adelberg questioned whether a required ratio of premium dollars to patient care was “worth the effort,” he encouraged transparent loss ratio reporting.

“A reporting approach is vastly better than arbitrarily taking a loss ratio from medical and assuming it works for dental,” Adelberg explained.

Adelberg pointed to successful loss ratio reporting approaches in Maine and California, which allow regulators to identify dental insurers taking in more premium dollars for administrative costs than they do for patient care.

But Gerrity said that dentistry deserved the same standard for insurers as any other essential medical care. 

“What we’re really looking to do is create parity, because oral health care is essential care,” Gerrity said. “And it’s often that patients will see their oral health care provider twice a year for routine cleanings and checkups, which is probably more than they’re seeing their primary care physician.”

According to Gerrity, some insurers may be spending just 40 cents of every dollar on patient care – roughly half what is required for medical care – based on surveys by the Health Policy Institute of the American Dental Association.

But without transparency, she said, Connecticut dental loss ratios remain unknown.

“Unfortunately, until we have this kind of reportability, there’s no way to know exactly where it is,” Gerrity said.

She said members of her organization had spoken to numerous members on the Insurance and Real Estate Committee prior to introducing the bill.

According to Gerrity, Committee Co-chair State Sen. Jorge Cabrera, D-Derby seemed willing to hold a public hearing, but his co-chair, State Rep. Kerry Wood, D-Wethersfield, was preventing the bill from moving forward.

“We have an overwhelming majority of people that are sitting in Hartford who want this to happen and it is incumbent upon the co-chair, Representative Wood, to stop blocking it,” said Gerrity by phone.

Gerrity claims Wood originally appeared in favor of the bill, but is now suggesting instead a working group to consider the issue over the summer. 

“While I would certainly want to work with her on that, I think that a working group is typically best suited for an issue that is too complex for legislators to handle – which I don’t think is the case,” Gerrity said.

In a call with CT Examiner, Wood denied detailed knowledge of the legislation – which she said missed the deadline for a public hearing – much less support.

“We will continue to work on things that people are passionate about, because that’s what our role is,” Wood said. “But I don’t even really know about this bill, so to tell someone that I supported it is false.”

Wood said it took a lot of time to get bills over the finish line, but that the creation of a working group on the issue was underway. She said legislators could also look to Massachusetts, who passed a similar dental loss ratio requirement though referendum last year, for data.

“[We can] see how people’s premiums went down,” Wood said. “I think it will give us the tools that we need for a working group to really dive into this over the summer and be prepared for a future session.”

In a call with CT Examiner, State Rep. Mary Mushinsky, D-Wallingford, said she introduced HB 5813 after she was approached last fall by Connecticut dentists who told her about the lack of dental protections in the Affordable Care Act and the recent passage of the Massachusetts law.

“It hasn’t gotten any traction so far. I would like to see something done,” Mushinsky said.

She said she’d appreciate a summer task force by either the Insurance and Real Estate Committee or the Public Health Committee, but also questioned whether she submitted the bill to the right committee. 

“I’m thinking I maybe should send it to the Public Health Committee, and not the Insurance Committee,” Mushinsky said. “I perhaps made a mistake sending it there, because Public Health Committee would be interested in this. No question.”

Whether through a working group or public hearing, Mushinsky still spoke to what she felt was the bill’s importance.

“I’m hoping that we’ll look at this because it is a reasonable thing to show what we get for our money, and to encourage people to actually use the care,” Mushinsky said.