In 2016, WSDA representatives met with the Office of the Insurance Commissioner (OIC) to come up with a plan to replace the “wellness plans” the OIC had determined were not consistent with Washington state insurance law. Grassroots advocates Drs. Greg Yen and Cindy Pauley (WSDA’s president-elect) worked with WSDA staff and contract lobbyists to build consensus for a path forward.
The OIC’s Concerns with Some Dental Wellness Plans
WSDA learned that the OIC had been investigating discount dental wellness plans that some dentists offer to their patients. The OIC investigations are generally complaint-driven, and when the office finds a program out of compliance with state law, it normally sends a cease-and-desist letter to the provider.
WSDA’s advocacy team reached out to the OIC’s Legislative Director and Deputy Commissioner of Legal Affairs to learn more about the OIC’s concerns, and how dentists might restructure their programs to address them.
While OIC understands and appreciates the goal dentists have to provide access to affordable care, it believes that some wellness plans do not comply with state law. Current law states that a provider (medical, dental, chiropractic, etc.) cannot offer discounts for a membership fee. Those arrangements are considered “discount plans,” which must follow specific laws and require registration and licensure as a “discount plan organization.”
OIC believes that providers cannot offer a subscription type of program because it is considered to be prepayment for medical services, and prepaid medical services are considered insurance that would be subject to the same regulation as insurance companies. There is a very limited circumstance in which this is allowed for medical care.
WSDA strongly believes that patients should benefit from a robust, diverse dental benefits market where patients can choose the type of dental benefit that is right for their situation. Dental wellness plans can provide a venue for patients to obtain necessary dental care and also prioritize prevention. WSDA sought to find a path forward for dental wellness plans that complied with all OIC regulations. Yen, a WSDA member who has spent considerable time creating dental wellness plans, worked with WSDA leaders and staff to develop a new way that did not include prepayment or any sort of membership fee.
WSDA worked with Drs. Yen and Pauley to provide advance materials and prepare for a meeting to discuss the matter. At the meeting with OIC, the team outlined the goal of providing an alternative consumer choice for dental care in today’s consumer-driven healthcare marketplace and establishing guidelines for prevention-based dental care programs. Experience has shown that in-office discounts and treatment credits incentivize use of prevention-based programs by patients by enhancing the sense of belonging to a dental home and encouraging return visits.
The model that was proposed to OIC called for the use of in-office vouchers or certificates that can be given to patients after their first annual visit to a dental office.
These certificates can be customized for preventive care, restorative care, or other services, and include “percentage off” discounts for treatment or a credit for a specific dollar amount. The certificates can also include specific expiration dates, and the same voucher system can be re-created in future years.
After deliberating upon the materials presented at the meeting, OIC sent official word to WSDA that the proposed payment model did not raise any regulatory concerns and had the green light to proceed.
Thanks to the hard work and creativity of Dr. Yen and other WSDA advocates, modified wellness plans will remain a viable alternative to traditional dental benefits, and an option to attract and retain patients.
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