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Cosmetic Dentistry Tax Did Not Pass In Washington State

Washington State recently proposed a sales tax on all cosmetic procedures. While this proposed tax would have mainly impacted medical doctors, it had serious implications for all family dentists in Washington State. The implementation of a retail sales tax on "cosmetic dentistry" procedures would have had terribly bad effects for patients. It would have put general Bellevue Dentists in the position of being tax experts by having to determine what would be taxable "cosmetic dental" procedures and what would not be a taxable "general dentistry" procedure. This would have been a nice cash cow the state legislators, but would have made nightmare situation for the average dentist to make such a determination. Insurance companies might begin listing many procedures as cosmetic so that they would not have pay the doctor or dentist.

Cosmetic Dentistry Tax Would Hurt Patients

The legislative bill as it was written to tax "cosmetic medical services", lacked clear language about what was or was not a medically necessary service to be taxed. If it was enacted, both family dentists and cosmetic dentists would have had the liability for the legal determinations of what was and wasn't a "cosmetic dentistry" procedure. These determinations could have been subject to audits and challenges by insurance companies, the State of Washington, and the IRS. Tax determinations should not be the job of health care providers.

Additionally, there would have been wide variations in what each individual dentist determines to be or not to be a "cosmetic dentist" service. This variation would most likely vary between various cities and counties depending upon the patient make up of individual dentists. In some cases, it may cause people to put off needed work because their dentist has determined that the work MIGHT BE considered cosmetic and it would therefore be taxable and increase the patient's bill. One example of this would be a person that is in an accident that breaks off part of a front tooth--it needs to be fixed for proper function, but it also has a cosmetic aspect in terms of appearance. Does that person get unfairly taxed for fixing that front tooth?? How about a person that has a decayed tooth extracted and now needs a new bridge or an implant to keep the teeth properly spaced for optimum function--it obviously has a cosmetic aspect also. Does that
person get unfairly taxed for maintaining proper tooth space and proper dental function?? The list of needed dental procedures that might be considered "cosmetic dental services" in various situations is very long. Would the need of more state money in subsequent years lead to the state legislature or state auditors increasing the number and types of general dental procedures or necessary dentistry services that fall into the cosmetic arena?? It could have happened if the tax had passed. The sponsor of similar legislation enacted in New Jersey in 2004 is at this writing attempting to have the "cosmetic tax" repealed, because it is unworkable.