By Michele Tulak-Gorecki, DDS
ADA 9th District Trustee
Dental insurance is arguably one of the biggest pain points for most dentists, their dental team members, and for the patients they serve. Consequently, the ADA and state dental societies have been trying to gain traction on this issue for a number of years with laws in various states that require dental plans to report medical loss ratio, or MLR.
The most recent states to enact such laws are Maine, Arizona, and California. An MLR requires the insurance company to spend a set percentage of premium dollars on actual patient care. Dental insurance MLR averages around 76% nationwide. However, these existing state laws don’t do what the MLR in medical care does for patients — provide a rebate to the patient if the insurance company doesn’t meet the MLR percentage requirement.
Now, all that may change, with the addition of a statewide ballot initiative in Massachusetts called Question 2. Dental insurers would be required to spend at least 83% of premium dollars on actual patient care. If they fall short, a refund of the difference would go to patients. If passed, this could be a watershed moment for dentists, dental team members, and patients across the country. Potentially, dental plans would have to be designed with more care, rather than less care for our patients.
How is organized dentistry responding to this initiative? The ADA Board of Trustees in September voted to authorize up to a $5 million contribution to support the Massachusetts initiative. Your own Michigan Dental Association authorized a $50,000 contribution at its last Board meeting. The Massachusetts Dental Society is working along with the ADA to encourage everyone from individual dentists, to all dental societies, and to DSOs to contribute financially to this initiative. Why? Again, a win in Massachusetts could set the stage for future dental insurance reforms nationwide. It could be the first domino for much needed dental insurance reform across the country. Most states wouldn’t need a state ballot measure, but could enact such reform through state legislatures. In that scenario, future advocacy requests could be, most likely, referred to state public affairs programs.
What does this mean for you? Please consider a contribution. The dental insurance companies will fight this effort. So, every single dollar counts! All dentists, dental team members, and patients will be the beneficiaries of this initiative. We are a dental family, standing together to protect and advocate for our patients. This is an issue that brings us together as the dental family we are and always have been.
The tides are turning and, I believe, this will be a membership value that is priceless. The ADA is on a new path — a braver and stronger organization than we have ever been. I can’t think of a time that I have been happier and prouder to be a dues-paying member of the ADA, MDA, and my local component. Together, we can be the best advocates for the profession of dentistry and the patients we serve. Dentists have always supported our patients receiving necessary care and, getting the maximum value for their plans will help achieve these goals. Let’s do this!
To find more information and to contribute to the success of Massachusetts Question 2, visit VoteYESon2forDental.com.
Contact 9th District Trustee Tulak-Gorecki at [email protected].