A resolution to a long-running debate between Rhode Island dentists and insurers over reimbursement rates is finally on the horizon.
Dentists in Rhode Island have long advocated for legislation requiring dental insurance companies to allocate a greater portion of dental premiums on patient care instead of administrative costs. The Fair Share for Dental Care Act introduced in the most recent General Assembly session proposed that insurers must spend at least 85% of premiums on care or refund the difference.
This is also known as a medical loss ratio, and proponents – including the Rhode Island Dental Association – say it would help make dental care more affordable for patients. Dr. Frederick A. Hartman, chairman of the association, previously told Providence Business News that he sees many patients who have dental insurance but still can’t afford the care they need. Sometimes patients spread treatments over years, causing pain and complications, while others forgo anesthesia to save money and endure painful procedures. Dental offices have even stopped accepting some insurance plans because of coverage limitations, he said.
The 85% medical loss ratio matches the federal Affordable Care Act, which requires medical insurers to spend at least 80% to 85% of patients’ premiums on care and quality improvements, said Rep. Joseph M. McNamara, D-Warwick, who along with Sen. Hannah M. Gallo, D-Cranston, introduced identical bills in each chamber.
The legislation is similar to measures that have been passed in other states, including Massachusetts, where voters passed a bond referendum in 2022 to establish an 83% medical loss ratio. There is no federal requirement for dental insurance.
However, opponents to the legislation – including Delta Dental of Rhode Island and the R.I. Office of the Health Insurance Commissioner – favored another measure that requires insurers to report their medical loss ratio information from 2023-2025 to OHIC. Then OHIC would send a report to the General Assembly as early as 2026 suggesting what the medical loss ratio should be.
The 85% medical loss ratio could mean fewer affordable plans would be available for individuals and small businesses, said Michelle Muscatello, Delta Dental vice president of communications and public affairs.
James Kinney, Delta Dental vice president of sales and business relations, said the insurer is not opposed to a ratio, but it needs to be studied.
“The number that might be right for us might be different for other insurers … it really should be the OHIC office choosing what that number should be,” Kinney previously told PBN.
Ultimately, the legislation for the 85% medical loss ratio was left on the table to allow the OHIC study to proceed.
Representatives for Delta Dental praised lawmakers for that decision, and Dr. Andrew Gazerro, Rhode Island Dental Association president, acknowledged that the study is a start and that lawmakers did make some progress on providing patients with more affordable care.
“[Providers] make money as patients can get more treatment done,” he told PBN. “Let us [do that] treating our own patients.”
For her part, Gallo said she’s not against the study, but her bill would have helped Rhode Islanders sooner. She said the outcome was a “meeting of the minds” among lawmakers and advocates where it was decided a study would be best so there was a set of facts to refer to when deciding what a medical loss ratio should be.
“I’m disappointed. I believe that the 85% share ratio is the most effective way to approach it,” Gallo said, adding she plans to continue introducing the bill even while the OHIC study is underway.
