Toothsome's employer dental agreement is now published on Mark Cuban Cost Plus Wellness as the platform's first dental contract. We shared the news in a press release, and the full terms are in the published agreement. This is the longer version: why it matters, how it works for employers today, and where we are headed.
Why dental deserves the same rethink
I'm an oral and maxillofacial surgeon and a co-founder of Toothsome. For years I have watched dentistry get funded through a system built for a different kind of risk.
Direct primary care has challenged the idea that every routine visit needs an insurance transaction. Dentistry deserves the same rethink.
Primary care has started to move that way. Dental has been slower to follow, and employer dental benefits are still traditionally administered through insurance.
Funding routine care and protecting against catastrophic financial risk are two different jobs. Insurance still matters for the big, unpredictable events. But an exam, a cleaning or a filling is predictable, and predictable care can be funded directly, with terms that anyone can read.
One thing to be clear about. The dental allowance is a limited benefit, not catastrophic coverage, and Toothsome is not an insurer.
How it works for employers today
The structure is simple. The employer chooses an annual dental allowance. Employees can use any licensed dentist under the plan's rules.
Under the published agreement's current service, the participant pays their dentist and the employer reimburses approved expenses through payroll. The administration fee is published in the agreement itself, so a self-funded employer or a benefits advisor can see the terms before ever talking to us.
That is the service the agreement describes today, and I would rather say so plainly than promise more.
Dentistry as part of primary care
The agreement is the first step. The bigger idea is that dentistry belongs inside primary care, not beside it.
Dentistry is an absolutely vital part of primary care. Oral health is part of overall health, yet the two are still funded and delivered as if they were separate.
A routine dental visit can surface things that have nothing to do with teeth, like uncontrolled blood pressure or an overdue screening. Too often, nothing connects that finding back to the patient's doctor.
We are developing medical-dental coordination to change that. The goal is to connect the dental visit to a patient's existing medical home, whether that is a direct primary care practice or a conventional medical group, with accountable handoffs and evidence that the care was completed. It is work in progress, and I will share more as it develops.
Get in touch
If you run a self-funded employer or advise employers on benefits, I would like to hear what you think. Read the agreement, then email me at samy@toothsome.io.