ADA News

Twelve states enacted noncovered services bills during their legislative sessions this year, with hopes from the ADA that more states will follow suit.

Dr. Walker

The states were among 29 that filed bills during the 2010 session to prohibit insurance companies from controlling what a dentist may charge for services the insurers don’t cover.

The 12 states—South Dakota, Virginia, Washington, Oklahoma, Oregon, Mississippi, Nebraska, Kansas, Idaho, Iowa, Alaska and Arizona—join Rhode Island in having a law on the books, a feat Dr. Mark Walker, member of the ADA Council on Government Affairs, said is impressive.

"It's been an incredible success rate, and we're very pleased with the response we've gotten from legislators across the different states," Dr. Walker said.

The restrictions of the bills differ depending on the state and some are stronger than others.

Iowa's bill is one of the strongest, differentiating its language by using the word "reimbursed" instead of "reimbursable." The distinction was necessary because the term "reimbursable" can be vague and ultimately lead to a broader number of services being subjected to insurers' fee limits, said Larry Carl, executive director of the Iowa Dental Association. Using the term "reimbursed" narrows the services upon which insurers can limit fees, he said.

"We were also fortunate in persuading the legislature not to allow carriers who also do third party administration for self-funded plans to rent their dentists' network to those self-funded plans that try to set maximum charges on noncovered services," Mr. Carl said.

The IDA's two lobbyists were up against 17 that registered against the bill, Mr. Carl said. Despite the strong insurance presence in Iowa and a tense period waiting for the governor to sign the bill, the IDA ultimately prevailed.

"It really was quite an undertaking, and it truly was the dentists that made the difference," Mr. Carl said.

The Virginia Dental Association also had challenges passing its bill. Gov. Bob McDonnell signed the bill April 13 after the VDA endured a long and aggressive fight with insurance companies to get it passed.

An insurer-labor coalition charged in a Web advertisement that Virginia residents would have to pay more out of their own pockets for dental services if the bill was passed. The VDA posted the opponents' ad on its website while urging legislative support for their own cause.

"I'm glad it's over," said Dr. Terry Dickinson, executive director of the VDA. "That was four months of intensity that we weren't quite prepared for. We just didn't realize the push back we would get from the insurance companies."

The Louisiana Dental Association was willing to make concessions with the language of the original bill in order to get some version passed. The final bill passed by the state legislature June 20 includes a clause that allows insurance companies to offer a contract to a dentist that would include fee caps as long as they also offer a version that does not, said Ward Blackwell, executive director of the LDA.

"It truly can be the dentists' option whether he or she chooses to engage in a contract like that or not," Mr. Blackwell said. "It can't be coercive in any shape or form."

The bill is pending the governor's signature,  and if it's given final approval, would take effect Jan. 1.

Moving forward, CGA is trying to keep its eye on the big picture, Dr. Walker said.

"We will continue to support the states in terms of being a resource for their bills that get brought forward," Dr. Walker said.

But CGA's main focus is at the national level and House Rule 5000, otherwise known as the Dental Coverage Value and Transparency Act of 2010, Dr. Walker said. The act would amend the Employee Retirement Income Security Act of 1974 to ensure health care coverage value and transparency for dental benefits under group health plans.

The American Dental Association legislatively opposes the practice of employing noncovered services. The ADA opposes any third-party contract provisions that establish fee limits for non-scheduled services, according to Resolution 59H-2009, passed by the House of Delegates.

The resolution also states the ADA will actively pursue getting federal legislation passed to prohibit ERISA-covered plans from applying such provisions. The ADA also encourages constituent dental societies to work on passing state legislation to prohibit insurance plans from applying such provisions.