Putting Patient Care First: Fixing Washington's Broken Dental Benefits System

It’s not flossing. It’s not inconsistent brushing or skipping checkups.

It’s something a little less clinical — but so essential to patient care: It’s the battle over dental benefits.

And this year, WSDA is pulling out all the stops to fix the broken system of dental benefits in Washington state.

The hard and fast reality is that dental benefits don’t really work for patients or the dental professionals who care for them.

So, who do they work for?

“We cannot overstate the influence of insurance companies on dental benefits in our state,” said WSDA Advocacy Director Kevin Schilling. “Too many patients are paying for dental benefits, only to be denied care because of insurance companies interfering in doctor-patient treatment decisions. Patients should have the freedom to choose the dentist that’s right for them, and unfortunately, some dental insurance carriers significantly decrease the amount they pay for claims when a dentist is not in their network,” said Schilling.

“That’s why we will be working with legislators to introduce legislation this session to ensure insurance companies provide the same benefit, regardless of who provides care. Dental benefits plans should respond to patient needs, rather than restricting access to safe, professional and cost-effective oral health care.

“WSDA’s advocacy team will be working this session to create a system that puts patients over profits, brings justice to care and creates a fair and functioning market. Because right now, insurance companies are not putting patients first,” he added.

“We believe these three reforms will make a dramatic difference for thousands of Washingtonians who work hard to pay for dental benefits, but whose claims are often denied when the time comes to access them,” said WSDA Executive Director Bracken Killpack.

“What’s more, the people who stand to benefit the most from these reforms are the people who need help the most: those with limited options and limited incomes, who can’t afford huge out-of-pocket expenses and require good benefits for access to care,” he added.

“This is very much an issue of health care equity.”

In Washington state, Delta Dental of Washington enjoys near-monopoly power in Washington’s dental benefits market. Despite having approximately 90% of Washington dentists in their network, Delta punishes patients who choose to be cared for by one of the other 10%. And Delta pays a mere fraction of the “usual and customary” service fees for such care.

According to data obtained by WSDA, Delta’s reimbursements for a basic care exam (the exam, bitewing X-rays and a cleaning) at a non-network dental office can be 41% less than they pay for in-network care, and 53% less than other carriers typically pay for out-of-network care.

“Without a doubt, we need better reporting transparency,” said Killpack. “Delta Dental’s anticompetitive behaviors are a key reason that dental benefits are broken in our state.”

So, if dental premiums aren’t going to patients, where IS that money going?

Tax filings from Delta Dental Washington indicate a history of significant compensation for its directors, executives and top leadership positions – more than twice its charitable donations. And while Delta’s corporate mission may be to “remove barriers and improve overall health,” the corporation’s incentive plan (which funds more than half of CEO Mark Mitchke’s multimillion-dollar compensation) does not include any measure of patient oral health.

Instead, the plan focuses on financial goals like profit margin — meaning that denying claims and paying substandard reimbursements will drive up executive compensation.

“The data is clear when you look at things like executive and board compensation, particularly in relation to claim volume and reimbursement rates,” Killpack said. “It’s all part of a well-orchestrated series of monopolistic practices that shortchange working people and their families who pay into dental benefit programs but are denied access to those same benefits when they see their dentists,” he added.

“It’s time to take back dental benefits for the patients who’ve paid for — and have a right to — those benefits for use with the dentist they choose and trust."

WSDA’s efforts to reform the dental benefits system will take precedent this session. That doesn’t mean the Association won’t try to advance additional measures to improve patient oral health.

Rounding out WSDA’s 2025 policy agenda: A slate of additional measures aimed at putting patient care first and addressing ongoing workforce challenges.

Washington’s health care system, like many others around the country, continues to face serious workforce shortages. A severe shortage of trained dental hygienists makes regular cleaning appointments difficult to schedule and more expensive. WSDA believes the solution to this challenge is to increase the preventive care workforce.

Building on last year’s success in launching the Dentist and Dental Hygienist Compact and new rules making it easier for hygienists moving into the state to begin working earlier, WSDA is proposing a series of additional steps the Legislature can take to do that, including:

Given the potential impact of these proposals, Schilling and WSDA Government Affairs Manager Lauren Johnson underscored the importance of WSDA members engaging with lawmakers, whether in person or by text or email.

“These are significant policy changes we are proposing. And with so many new legislators taking office next session, it will be more important than ever for WSDA members to connect with their local legislators and help educate them about our policy platform and why these changes are needed,” said Johnson. “If you haven’t signed up for Dental Action Day, please consider making the trip to Olympia on January 30. But effective advocacy will require ongoing contact well beyond that one day. WSDA will need everyone’s help to make lawmakers understand how these policy changes support patients and better oral health outcomes.”

“WSDA members remain committed to addressing the dental benefits, workforce, and other challenges that are facing the profession,” Schilling added. “Our 2025 agenda reflects that willingness to find innovative solutions that ensure greater access to care for all people in Washington state.”

WAYS TO GET INVOLVED

• Sign up for WSDA text alerts: Stay in the know and help us take action at crucial moments in the legislative session. To sign up, text WSDA to 52886.
• Be prepared to take action: Things change quickly in the Legislature. Be prepared to contact lawmakers when you receive call-to-action alerts from WSDA during the 2025 session.
• Identify and contact your state legislators: If you need help confirming who represents you in Olympia, it’s easy to find out. Just visit https://app.leg.wa.gov/districtfinder.