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Dental Benefits Under Healthcare Reform Assessing the risks and opportunities for advocates of oral ... - page 7 / 24

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Dental Benefits Under Healthcare Reform

Legislative and Regulatory Trends

Regulatory micromanagement on the rise

Language assistance, provider sufficiency (timely access), rate regulation, any willing provider, assignment of benefits, prompt payment, independent review, retroactive termination, etc…

All intended to protect consumers from bad players and practices

All intended to address complaints about health plans, not dental

For low margin benefit like dental, these add up to “death by a thousand pinpricks”

Emergence of the “plan enforcement model”

By regulating “practice of dentistry” through dental plans, we risk defection of dentists from panels, which equals higher costs, higher premiums and less access. (example, timely access regs)

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