Third Party Coverage
The ADA provides technical support to help state dental societies advance their respective policy agendas. This includes addressing legislative and regulatory proposals that would affect the way dental insurance is defined, offered, and administered at the state level.
Current Policies (PDF) is the latest published edition of major policies and positions adopted by the ADA House of Delegates.
Third party coverage and payment issues that commonly arise at the state level include, among others:
- Medically-Associated Dental Care—Requiring medical insurers to cover (and act as the primary payer for) dental treatment associated with a diagnosed medical disease or condition.
- Coordination of Medical/Dental Benefits—Requiring medical and dental insurers to coordinate primary dental and secondary medical benefits (or vice versa) in a way that is seamless for both the patient and treating dentist.
- Joint Disorders—Encouraging medical and dental insurers both to offer coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders.
- Non-Covered Services—Prohibiting dental insurers from interfering when a contract dentist agrees to furnish a non-plan service privately to a patient who knows the service not covered by his or her plan (e.g., capping fees for a non-covered cosmetic procedure, etc.).
Dental Society Resources
The ADA Department of State Government Affairs (DSGA) offers resources to help state and local dental societies benefit from the best practices and lessons learned in other states and municipalities.
For additional information or to request assistance, please contact the DSGA at 312.440.2525 or firstname.lastname@example.org.
STAY INFORMED about the latest legislative and regulatory happenings.
- Subscribe to the monthly e-publication, Government and Public Affairs Update.
- Access the State Legislative Report (members only).
- Subscribe to the RSS feed for ADA News Today.
- Learn about legislative and regulatory issues that could affect dentists as practitioners, employers, and consumers.
TAKE ACTION by talking to your legislators.
State Government Affairs
211 East Chicago Avenue
Chicago, IL 60611