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ADA, AOA support bill to prohibit fee setting for noncovered services

March 21, 2017

By Jennifer Garvin

Washington — The ADA and American Optometric Association announced their support March 21 for the Dental and Optometric Care Access Act, proposed federal legislation that would prohibit dental and vision plans from setting fees for noncovered services.

H.R. 1606, also called the Doc Access Act, is supported by Rep. Earl L. “Buddy” Carter, R-Ga., and Rep. Dave Loebsack, D-Iowa. The bipartisan legislation would prohibit all federally regulated plans from offering nominal payments for otherwise noncovered services in an effort to have such services considered covered. The bill would also prohibit plans from imposing restrictions on medical plan participation and setting limits on a doctor's choice of lab.

“The DOC Access Act is critical in ensuring doctors meet patient needs,” said Rep. Carter in a statement. “By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need. This legislation is a strong and necessary step in bringing free market principles back into health care by removing anti-competitive business practices.”

The bill also prohibits plans from communicating with enrollees in a manner that interferes with the doctor-patient relationship. For instance, some plans require doctors to participate in plans for network access or require that specific labs perform testing. This law would eliminate these types of mandates.

“This is really great news," said ADA President Gary Roberts. “I want to personally thank Congressmen Carter and Loebsack for introducing this bill. Dental insurance companies must be prohibited from interfering in the doctor-patient relationship by dictating prices for services they don't even cover. While many states have passed similar laws, the Carter-Loebsack legislation would ensure the prohibition applies to federally regulated plans. 

“Millions of Americans rely on local doctors of optometry for their comprehensive eye and vision health care needs, and it is time to put a stop to the barriers vision plans place on the doctor-patient relationship and access to quality care,” said AOA President Andrea P. Thau. “The AOA is proud to support the DOC Access Act and commends Reps. Carter and Loebsack for taking this step to ensure that doctors and patients are again at the center of important, personal health care decisions.”

To date, 39 states have passed legislation to limit non-covered services provisions in dental and vision plans. Even with state legislation, the DOC Access Act can help dentists 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.

Original-co-sponsors of H.R. 1606 include Reps. Bennie Thompson, D-Miss., Markwayne Mullin, R-Okla., Robert Pittenger, R-N.C., and Paul Gosar, R-Ariz., a dentist and ADA member. 

For information about all of the ADA’s advocacy activities, visit ADA.org/advocacy