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.
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.
- 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.
- Coordination of Benefits—Requiring medical and dental insurers to coordinate primary and secondary benefits (and payments) in a way that is seamless for both the patient and treating dentist.
- 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.).
Current Policies (PDF) contains major policies adopted by the ADA House of Delegates.
The ADA Department of State Government Affairs (DSGA) offers resources to help state dental societies and lawmakers benefit from the best practices and lessons learned in other states.
For additional information, please contact the DSGA at 312.440.2525 or email@example.com.
More ADA Resources
State Government Affairs
211 East Chicago Avenue
Chicago, IL 60611