Dental insurance issues are often rated among the most important concerns confronting dentists. We are working at both the state and federal level to address these insurance concerns, including provisions in dental plans that dictate how much dentists may charge a plan enrollee, even though the services provided to the enrollee are not “covered” (i.e., paid for) by the plan.

The ADA supports the Dental and Optometric Care Access Act (DOC Access Act), legislation that would prohibit dental and vision plans from setting the fees network doctors may charge for services not covered by the insurers. As you know, non-covered services provisions in dental and vision plans disadvantage enrollees, doctors, and the public at large because they interfere with the patient-doctor relationship, skew the pricing charged to non-subscribers, and encourage the consolidation of the dental and vision insurance industries, resulting in higher premiums overall.

That’s why I’m asking you to write your Senators and Representative to urge them to support legislation that will address consolidation of larger plans. The “take it or leave it” behavior of these plans is an unacceptable leveraging of their greater market share to push doctors into accepting provisions, such as non-covered services. These practices place the smaller dental and vision carriers at a competitive disadvantage and shift costs rather than reducing them.

Today, we are asking you to tell your Senators and Representative to support S. 1424/H.R. 1385, which would:

• Establish some “rules of the road” for provider network participation;
• Prevent plans from establishing nominal payments for otherwise non-covered services in an effort to have such services considered covered inappropriately;
• Limit network agreements to two years for each contract extension unless the doctor agrees to accept a longer contract extension; and
• Preserve doctors’ freedom of choice in laboratories.

Please email your Senators and Representative and ask them to support this bipartisan legislation. In doing so, they can help bring needed equity to insurer/provider contracting nationwide.

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