Group hits MLR requirements for dental insurance plans as ‘bad policy’ – InsuranceNewsNet

Forcing dental insurance plans to adopt medical loss rate requirements similar to health care plans is “bad public policy that does not achieve the intended consumer and dental community benefits.” The Executive Director of the American Dental Planning Association said so.

NADP’s Mike Adelberg has vehemently criticized the issue, saying the health care loss rate requirement is a top priority for discussion at the organization’s annual leadership meeting this year.

So-called MLRs have been introduced into healthcare planning for over a decade with the passage of the Affordable Care Act. The plan accepted his MLR in exchange for tens of millions of new federally funded members. This does not require the health insurance company to spend more than 10% to 15% of his on administrative expenses, and requires that the majority of the revenue be explicitly directed towards medical care. Plan members receive a premium her rebate when the plan exceeds administrative spending requirements.

Dental insurance plans, which are typically structured more like gift cards than traditional health insurance, have been exempted from ACA regulations. However, they have since been targeted by advocates and dental associations for inclusion in his MLR. Especially when it comes to light that some plans admit outliers, spend little on actual dental care, and spend huge sums on administrative costs, including high executive salaries. . .

And last November, voters in Massachusetts adopted MLR in their state’s dental plans by a margin of 72%. Supporters said ensuring that most of their premiums are spent on care is a big win for consumers. He said the move to align medical and dental plans would likely sweep the country.

Massachusetts vote was a ‘mistake’

But Adelberg said Massachusetts’ vote was a “mistake” and was approved without the benefit of a legislative process that allowed experts to weigh the pros and cons. If forced to do so, it said member and provider call centers could be closed, impacting claims processing.

“No one, not even dentists, will benefit from a reduction in planning services,” a statement posted on the NADP website said. His organization said it strongly opposes imposing medical loss rates on dental plans that arbitrarily set MLR levels.

“More than 80% of MLR dental plans are not consumer oriented,” he said. “It increases cost sharing and limits provider choice.”

Not surprisingly, the American Dental Association (ADA) refutes the NADP’s position, saying that for too long dental plans have had the oversight necessary to ensure that most of the premiums they collect go toward treatment. said that it existed without

Chad Olson, director of state government affairs at the ADA, said, “In the COVID era, these companies had very low health care loss rates even though they were still collecting premiums.” Had it been established, consumers would have been able to get their hard-earned dollars back.

Olson specifically criticized Adelberg’s hypothetical example. In it, he said a much higher cost share outweighs the promise of a small rebate.

To raise the cost of treatment to meet the required MLR, “Imagine a dental insurance that pays $1,250 for crowns now pays $1,500,” says Adelberg. “A consumer who shares 50% of the cost of this service will pay $125, half of this cost increase. In that case, the consumer will pay 100% of the additional costs.”

“Our hope is to make choices to meet the MLR that benefit the patients the plan serves.”Chad Olson, Director of State Government Affairs, ADA

But Olson countered that there are other options available for dental planning besides raising the cost of dental care.

“Using his example, a dental plan could increase its cost share for crowns from 50% to 60% and keep what the plan ‘pays’ at $1,250,” he said. “In that scenario, the plan would currently reimburse $750 and the consumer would be responsible for $500, saving the consumer $250 … our hope is that the plan will provide It’s about making choices that meet the MLR that benefit patients who do.”

Connecticut, Nevada, and Oklahoma have already announced their intention to take similar steps, and others will join.

“In line with our mission to improve consumer access to affordable, quality dental care, NADP will be increasingly involved in state-level legislative efforts to combat MLR requirements for dental plans. ‘ said Adelberg.

But the ADA, whose members spent $5.5 million on the Massachusetts campaign, pledged to fight for the MLR in kickbacks.

“The dental insurance industry opposes this reform because they want to continue business as usual,” said Olson. “Consumers are more mindful of their wallets than ever, so we believe they deserve as much as possible from the premiums they pay for dental insurance … Legislators and the voters they serve need this. good consumer protection and timely.”

“Fear-creating fraud by NADP is expected,” said Mouhab Z. Rizkallah., He is chairman of the Quality of Dental Insurance Commission and an orthodontist in Maine with primary responsibility for getting the issue to the ballot. “It will only delay the imperative of all states having dental MLRs and improving dental insurance in all states,” he said.

Doug Bailey is a journalist and freelance writer living outside Boston.he can be reached at [email protected].

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