Relates to insurance coverage for bruxism diagnosis and treatment

◆ The sponsor's argument

Why Joseph P. Addabbo Jr. says this is needed

Bruxism, commonly known as chronic teeth grinding or clenching, is a serious and often progressive oral health condition that can result in enamel erosion, fractured teeth, gum recession, temporomandibular joint dysfunction, chronic pain, sleep disruption and irreversible tooth loss. Left untreated, bruxism frequently necessitates extensive restorative dental procedures, including crowns, root canals, implants, dentures and oral surgery. Although many dental insurance plans nominally indicate coverage for occlusal guards or night guards, patients and providers routinely encounter reimbursement barriers, restrictive medical necessity stand- ards, and utilization review practices that make such coverage inacces- sible in practice. In many cases, licensed dentists receive little or no reimbursement for the clinical evaluation, diagnosis and treatment plan- ning associated with bruxism, creating a systemic disincentive for early diagnosis and preventative intervention. As a result, patients are often forced to delay treatment until signif- icant and irreversible dental deterioration has already occurred. These barriers disproportionately impact low-income individuals, Medicaid recipients, individuals with disabilities and underserved minority communities, all of whom face greater obstacles in accessing preventa- tive oral healthcare and affording custom fabricated occlusal guards out-of-pocket. This legislation addresses these failures by establishing meaningful insurance reimbursement for the diagnosis and treatment of bruxism and by requiring coverage for medically necessary occlusal appliances prescribed by licensed dental providers. By incentivizing preventative care rather than costly restorative intervention, this bill seeks to improve oral health outcomes, reduce preventable tooth loss, advance oral health equity and lower long-term healthcare expenditures associ- ated with untreated dental disease. New York has long recognized the importance of preventative healthcare and consumer protections in the insurance marketplace. This legislation builds upon those principles by ensuring that New Yorkers have meaningful access to clinically appropri- ate preventative oral healthcare before permanent dental damage occurs.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.