Dozens of dentists and dental students stood behind Assemblymember Matt Haney, D-San Francisco, during a press conference this week in Sacramento to show their support for a bill intended to enhance dental care accessibility and prohibit dental insurance companies from requiring out-of-pocket payments for covered services.
“As things stand, dental insurance companies are able to use loopholes to deny people access to care,” Haney said at the Tuesday press conference outside the California State Capitol Museum.
“Dental care should be affordable, accessible and timely. It shouldn’t be an hour from where they live or work. It shouldn’t be something they have to pay for out-of-pocket when they’ve already paid for insurance,” he said.
Assembly Bill 371 would mandate that dental insurance companies in the state provide enrollees access to in-network dentists within 15 miles of the patient’s residence or workplace. Existing law does not specify that dental insurance companies have to abide by distance parameters for care they cover.
It would also ban dental insurance companies from forcing enrollees to pay out-of-pocket for services covered in their insurance plan. That would prevent insurance companies from subsequently denying coverage for patients who seek services out-of-network, despite having insurance plans that are supposed to cover out-of-network care.
Patients are sometimes referred to specialists who are out-of-network for services that are supposed to be covered by their insurance plans. However, patients are often told they need to pay out-of-pocket, hoping that they will be reimbursed.
“Unfortunately, many times it is not reimbursed as we see incredible high rates of denials for some dental insurance companies,” Haney said.
There are loopholes in coverage plans that dental insurance companies can get around to avoid paying for certain services, Haney said. That leads to patients feeling uncertain their insurance will cover the care they need, leading them to walk away from dentist offices without receiving proper care for their teeth.
“You’re told by dentists that you might get this covered and then you’re given an astronomical cost for it,” Haney said. “Many people will just turn away and not get it done at all.”
Current state law requires dental insurance companies to secure appointments for urgent care within 72 hours of request, non-urgent care within 36 business days of request, and preventative care within 40 business days of request.
AB 371 would shorten these time requirements to 48 hours for urgent care, 18 business days for non-urgent care, and 20 business days for preventative care.
Another aspect of the bill would require the state’s Department of Managed Health Care or the Department of Insurance to serve as a watchdog over insurance companies to monitor if they are complying with the bill’s mandates.
“Dental care should be affordable, accessible and timely. It shouldn’t be an hour from where they live or work. It shouldn’t be something they have to pay for out-of-pocket when they’ve already paid for insurance.”
Bill author and Assemblymember Matt Haney, D-San Francisco
Jennifer DiGrande is a San Carlos resident who recently switched to a new insurance plan with Delta Dental, one of the largest dental insurance providers in California.
She spoke during the press conference to share how she struggled to find in-network dentists in her area.
“I have been unable to find a dentist that will take our insurance,” DiGrande said.
“I’ve called three dozen dentists I have not been able to secure an appointment. The closest appointment I have been told I may have access to is in June,” she said.
Delta Dental did not respond to a request for comment.
Other states like Maryland, Oregon and Colorado have already enacted similar legislation that enforces stronger requirements for dental insurance providers, according to Haney .
“There are many other states who already have this standard of requiring folks to be able to have timely, accessible care close to where they work or live. That is something that Californians deserve as well,” Haney said.
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