State lawmakers closer to bridging gaps in coverage for dental procedures


As president of the Illinois State Dental Society and a pediatric dentist, I am thrilled to see that dental insurance reform legislation is gaining traction in Illinois. With key reforms passing Illinois House and Senate committees in recent weeks, we are one step closer to providing our patients and their families with the dental coverage they need and deserve.

One of the most frustrating challenges our patients and families face is limited and sporadic dental insurance coverage. Many are often surprised at the amount they are required to pay out of pocket, and this can be especially true for children with various oral health treatment needs. We often see insurance simply will not cover services that are widely accepted as the standard of care.

I have seen firsthand the devastating effects of limited dental insurance coverage on our patients and their families. Recently, I had a young patient who required work on 12 teeth, but his insurance would not cover general anesthesia. As a result, he had to endure four visits, and each time both the boy and his mom struggled in tears. It was heart-wrenching for him, his family, and our staff, who could see the emotional toll it was taking on everyone involved.

Dental insurance barriers like this are not just an issue of inconvenience; they can have a real and lasting impact on our patients’ health and quality of life.

Limited dental insurance coverage has had a detrimental impact on patients and their families for far too long, especially for those who cannot afford high out-of-pocket costs. Necessary procedures are often not covered or are severely restricted, leaving patients to shoulder the burden of costly out-of-pocket expenses or delay critical oral care. All the while, dental insurance companies continue to go unchecked, with up to 40 percent of patient premiums going toward administrative costs that include extravagant marketing and executive bonuses.

This is why the Illinois State Dental Society has launched the More for Your Smile campaign, which advocates for reforms that remove barriers to care and ensure that patients and employers get better value for their money. The legislation removes barriers to care by requiring dental insurance companies to direct at least 80% of patient premiums toward patient care, ensuring patients and employers will get better value for their money, and that out-of-pocket costs are reduced. It also puts an end to schemes used by big insurance companies to gain additional revenue streams that hurt dentists’ abilities to maintain financially healthy practices and ultimately impact patient access to care.

The solution is clear. More patient premium dollars should go toward patient care, not insurance companies. I am encouraged that lawmakers in Springfield are considering reforms that could make a real difference in the lives of patients across our state.

Patients can join these efforts to help give children and families better access to the dental care they need and deserve by contacting their lawmakers and urging them to support More for Your Smile legislation.

Help us send the right message to big dental insurance executives: It’s time to put patients first and ensure that dental insurance coverage meets their needs, not the needs of insurance company profits.

Dr. Kenneth G. Rawson is president of the Illinois State Dental Society.

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via The Breeze-Courier

May 14, 2023 at 09:05AM

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