Letters: Noncovered services
March 04, 2013
Our patients rely on what is covered by their insurance policy, and those of us dentists who take insurance need to be familiar with evolving insurance models. The majority of states have adopted legislation called noncovered services laws, which limit or prevent insurers from dictating fees on services they do not cover. Noncovered services agreements are in the contracts of dental benefit provider networks and in my opinion, undermine the conventional dental insurance model. If we as dentists are complacent about allowing this type of dental insurance to exist, it will forever change dentistry in our country. Further, I believe that as the Affordable Care Act regulations come into play, more insurance companies will transfer to the more profitable noncovered services model.
With noncovered services, one particular insurer may offer several different plans at increasing costs for increased benefits to the employer, but the dentist is expected to accept the same allowances across the board; even for some plans offered by the insurer that exclude basic dental needs. This leaves the patient or employee and the dentists to bear the burden of accepting lower reimbursements and dentists having to explain the details to patients.
When the patient-doctor relationship has been established, the patient invests his or her trust in the competent decisions made by their dentist to deliver the best quality care. Patients assume that the dentist has their health and welfare as priority; not what their insurance covers and does not cover. As noncovered services becomes mainstream, it will compromise the patients' quality of care. A majority of dentists will either not make certain treatments available due to cost constraints or not take insurance that a majority of patients have.
As state legislators meet across the country and in Washington, D.C., organized dentistry has the opportunity to defend our profession by introducing legislation to protect dentists from noncovered services clauses in insurance contracts as endorsed by the ADA. Many of our specialty and professional dental organizations have successfully advocated for 30 states to pass legislation governing noncovered services, and five other states are pursuing legislation this year. We can stand together proactively not only to address legislation on the state level but to also include federally regulated plans by educating our patients, our legislators and our colleagues to encourage legislation to protect our patients and our profession's future.
Steven A. Saxe, D.M.D.
Editor's note: The ADA has a policy, Maximum Fees for Noncovered Services (Trans.2010:616), which offers a definition of noncovered services. The policy calls for the ADA to oppose any third-party contract provisions that establish fee limits for noncovered services, and defines "covered service" as any service for which reimbursement is actually provided on a given claim and any service for which the third party provides no reimbursement.
The policy urges the Association to pursue passage of federal legislation to prohibit federally regulated plans from applying such provisions, and encourages constituent dental societies to work for the passage of state legislation to prohibit insurance plans from applying such provisions.