Ohio Senate Insurance Committee April 12, 2016

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Ohio Senate Insurance Committee

April 12, 2016

Opponent Testimony of Sandi Davis, Union Benefits Trust

HB 95
Good morning Chairman Hottinger and other esteemed members of the Senate Insurance Committee. Thank you for the opportunity to share our testimony.

My name is Sandi Davis, an employee of the Union Benefits Trust where I manage the dental insurance plan covering approximately 80,000 union represented State of Ohio employees and their families.
Our testimony today is in opposition to HB 95, legislation uncaps the fixed dental fees chargeable for non-covered services.
While there are many reasons this legislation is a bad idea, I’ll focus today on costs and oral health issues.
Let’s start with cost. There is significant importance in the fact that dentists who see uninsured patients of which all services are non-covered services, the dentist may charge whatever they like for their services. Current Bureau of Labor statistics show 45.4% of workers had access to dental insurance coverage. This clearly shows that dentists are able to strike a balance between the number of discounted fee (insured) patients and full fee (uninsured) patients they have in their practice. I personally know of dentists who have temporarily stopped accepting insured patients to realign that balance. And just for fun, the BLS lists the annual average salary of a dentist in private practice at $163,000+. The BLS listed the annual average salary of a family physician at $151,000+.

Let me use Dr. Moore’s, testimony to further make this point. He states: “HB 95 would prohibit dental insurance companies from dictating fees for dental services they do not even cover for their enrollees.” I would remind the committee, that most dental insurance is employer-provided insurance; therefore, the employer is the one who decides what services will be covered, not the employee and not the insurance company. The employer will purchase what they can afford. If these dentists were honest, they know for example, that an implant for one missing tooth is far less invasive than a bridge, which will compromise the integrity of two additional teeth. However, implants have been thought of as cosmetic and expensive until recently causing the addition of this coverage to come about very, very slowly with employer groups. Insurance companies do provide coverage for implants, but not all employers purchase that coverage as part of their plan.

Dr. Moore also states in his testimony that he placed an implant for a patient who had no coverage for implants and knew that going in. Dr. Moore states “However, shortly after the initial implant was completed, I received notice from her dental insurer that there was a limitation on how much I could charge this patient for the performance of her procedure.” The very limitation he pretends to be surprised by in this case, is in fact, the very heart of this bill. Don’t let him get away with pretending not to understand the provision, yet having the wherewithal to submit detailed testimony in support of the measure.
He goes on, “The insurer was setting the fee for the implant even though the insurer did not cover or in any way contribute to the cost of the implant. This limited fee set by the insurer was actually less than what I had expended in supplies, lab costs and staff time. My business lost money performing the implant. The next time the patient came to my office I explained what had happened and told her that I would not be able to perform her additional implants due to the fee limitation.” So if I understand his statement, he is willing to take a loss for patients who have implant coverage, but not for patients (even extremely loyal patients) who have no coverage despite the loss of income being the same. I believe Dr. Moore was less than honest with his patient and owes her a huge apology.
In my capacity, I’ve spent a great deal of time on network recruitment with various carriers over the last 23 years. Here’s how this works: a dentist needs patients to be successful, right? In its simplest form, dentists join insurance carrier networks with the sole purpose of increased patient volume and in return, accept discounted fees on covered and non-covered services. At any point, the dentist has the choice to terminate the contract, freeing them from discounted fees for both covered and non-covered services. To leave the network however, puts the practice at risk of angering their insured patients at the least, and possibly losing those patients to other network dentists to thwart off any increase in their out of pocket costs. The dentists made a conscience decision to contract with this carrier knowing the provisions of the contract and the promised return on the investment of being a network provider. It seems unconscionable that they and the Ohio Dental Association who represents them now wish to remove those provisions through legislative action. They have every right to choose not renew those contracts in the future, but until such time, they must be made to keep the promises they made.
So let’s spend some time on oral health issues. With so much information surrounding the correlation between oral health and overall health, is this really the time to put a higher price tag on these services? If we are to continue the strides being made in our attempts to control the cost of health care as a whole, we must not change the current landscape with respect to capped dental fees.
We know there is a correlation between heart disease, diabetes, osteoporosis, and pre-term, low-weight babies, and periodontal (gum) disease which is used in this example. Gums hold our teeth in place. Periodontal disease erodes the gums and leads to tooth decay, loss of teeth and bone. Following an invasive planing/scaling or surgical procedure to correct periodontal disease, the patient should have periodontal maintenance (high level cleanings) every three months to build upon the success of the treatment. Most dental insurance plans don’t cover periodontal maintenance visits; hence, the patient would be responsible for the full cost. Ok, so that’s bad enough on its own, but if by chance that patient suffers from diabetes and can no longer afford the maintenance visits because discounts no longer apply, the sugar in the uncontrolled gum disease further exacerbates their diabetes and not only does the patient end up back at square one with their oral health, but there could be increased medical care costs involved as well. This is just one example.
For these reasons alone, we strongly urge you to vote no on HB 95. Thank you again for the opportunity to testify in opposition of HB 95. I would be happy to answer any questions.

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