Intro

Dental insurance rules are changing fast, and “dental loss ratio” (DLR) is becoming a key issue dentists can’t ignore. In this episode, Kirk Behrendt sits down with Shelley DeGroff of PPO Advisors to explain what DLR is, how it works, why states are adopting it, and what it could mean for premiums, access to coverage, and the future of PPO participation.

You’ll learn how DLR is measured, what accountability could improve for patients and practices, and where to watch for state-by-state updates as the market shifts. Listen to Episode 1044 of The Best Practices Show!

Main Takeaways:

• Dental loss ratio (DLR) is the percentage of dental insurance premium dollars spent on patient care rather than overhead, administration, or profit.
• DLR is state-specific legislation, and states can require carriers to meet a target percentage or refund premium dollars back to patients.
• The current national average DLR discussed is about 64%–67%, which is driving efforts to push DLR targets into the 80% range.
• As DLR expands, dentists may see operational improvements like fewer denials and faster claims processing, depending on how carriers respond.
• One downside risk is that some carriers may raise premiums or exit certain markets, making coverage harder to find or more expensive for employers and patients.
• NCOIL (National Council of Insurance Legislators) has a model DLR framework that states can use as a starting point when drafting legislation.
• Dentists should track DLR activity through their state dental society and stay engaged in the legislative conversation as changes accelerate.

Snippets:

00:00 Why dentists need to understand dental loss ratio (DLR).

04:00 What DLR is and how premium dollars are measured against patient care.

06:00 How state DLR laws can trigger refunds of premium dollars to patients.

09:00 The national average DLR discussed (64%–67%) and the push toward the 80s.

10:00 Why brokers may feel the squeeze first as carriers adjust to DLR pressure.

12:00 How relying on PPO lists can become riskier as networks and rules shift.

13:00 A warning sign: treatment planning based on insurance instead of clinical judgment.

18:00 What NCOIL is and how it influences state DLR bills.

19:00 How DLR could mirror medical loss ratio dynamics, including premium pressure.

24:00 Where to start: practice evaluation and understanding how insurance impacts the business.

Guest Bio/Guest Resources:

Shelley DeGroff, founder and CEO of PPO Advisors, knows dentistry. After graduating from the University of Nebraska, she began working as a dental receptionist in a nearby dental office. After completing her certification as a dental assistant, Shelley transitioned to become a successful office manager. It was in that role that Shelley began noticing the need for PPO negotiations for her employing doctor. This experience began the business model for PPO Advisors, which has now become a nationwide industry leader.

Resources mentioned in the episode:

• PPO Advisors website: https://ppoadvisors.com/
• PPO Advisors blog: https://ppoadvisors.com/ppo-insights/blog/
• NCOIL (National Council of Insurance Legislators) model dental loss ratio framework:
• https://ncoil.org/wp-content/uploads/2024/01/NCOIL-DLR-Model-Health-Cmte-Adopted-1-26-24.pdf

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