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Dentists have increasingly been squeezed by PPOs and dental insurers for years. Now, it seems, dentists in California are angling to squeeze back by arguing for insurers to cover the costs of Covid-related PPE.

For instance, according to an article in the LA Times, costs for N95 masks have increased 12-fold while the price for a box of 100 gloves has gone up 15 times what they cost in February 2o20. 

Those in favor of insurers paying for increased costs argue that insurers collected premiums during the pandemic while paying out relatively little in premiums. Insurers respond that California dentists already received federal aid during the height of the pandemic in the form of Paycheck Protection Program funds and some $9.9 billion in funds distributed by the U.S. Department of Health and Human Services. 

The Rich Get Richer?

The Kaiser Family Foundation performed an analysis that found “most health insurance companies became more profitable during the pandemic. Overall, they collected more premiums from members each month than they paid out in claims, and spent a lower percentage of premiums on medical claims in 2020 than they did in 2019.”

A spokesperson for the California Assn. of Health Plans indicated that the organization considers expenses for masks and gloves to be “non-medical expenses,” a stance which may be difficult to justify given the unique challenges of the pandemic.

Attempts to have the Centers for Medicare and Medicaid Services approve a procedure code that would allow for reimbursement for Covid-related expenses were denied, leaving the issue in limbo for now. However, Washington state passed a law mandating additional per-patient reimbursement, and California’s legislature is in the process of debating legislation, SB 242, which is less defined than Washington state’s but may still be enacted into law.

Will dentists turn the tables on PPOs and insurers? The old saying, “As California goes, so goes the nation.” may apply here. We’ll keep you posted.

Smartbox

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