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ADA, optometric association encourage federal legislation to eliminate noncovered services

March 23, 2016

By Jennifer Garvin

Washington — The ADA and American Optometric Association are working together to get Congress to pass federal legislation eliminating insurance companies' practice of setting prices on procedures not compensated by plans.

H.R. 3323, the Dental and Optometric Care Access Act, introduced by Rep. Buddy Carter (R-Ga.), would prohibit all federally regulated dental and vision plans from offering nominal payments for otherwise noncovered services in an effort to have such services considered covered.

"The ADA and the American Optometric Association believe that patients are adversely affected by provisions in dental and optometric benefit plan contracts that dictate what a doctor may charge a plan enrollee for items or services not covered by the plan," wrote ADA and AOA in a joint statement.

American consumers are "disadvantaged by the negative impact of noncovered service provisions on competition among entities in the health insurance industry and all would benefit from this legislation," wrote the ADA and AOA.

H.R. 3323 also would:

  • Permit changes to the provider network agreement only when agreed to in writing by the doctor.
  • Limit network agreements to two years.
  • Prohibit retaliatory measures such as denying entry or continued participation in a network if the doctor declines to participate in any specific plan or coverage.
  • Prohibit plans from communicating with enrollees in a manner that interferes with the doctor-patient relationship.
  • Not restrict the doctor's choice of laboratories.
  • Provide a private right of action (injunctive relief and damages) for a person adversely affected by a violation of the above provisions.
To date, 39 states have passed legislation to limit noncovered services provisions in dental or vision plans. Even with state legislation, the DOC Access Act can help because many insurance plans fall under the Employee Retirement Income Security Act and, as such, can claim that they are not covered by the state laws.

For more information about H.R. 3323, visit ADA.org/advocacy.