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ADA reaffirms support for Dental and Optometric Care Access Act

April 25, 2017

By Jennifer Garvin

Washington — The ADA is reaffirming its support for the Dental and Optometric Care Access Act following the National Association of Dental Plan's opposition to the bill.

In March, the Association and American Optometric Association announced their support for H.R. 1606, the Dental and Optometric Care Access Act, which was introduced by Rep. Earl L. "Buddy" Carter, R-Ga.

Also called the DOC Access Act, the bill prevents federally regulated plans from noncovered services practices, including offering no or nominal payments for services dictated by the plans and also from imposing restrictions on medical plan participation and setting limits on a doctor's choice of lab. To date, 40 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.

In an April 3 letter to Rep. Carter, the National Association of Dental Plans stated its opposition to the bill, saying that it "denies insureds the benefit of discounts negotiated for both covered and noncovered services which negates one of primary values of insurance."

In an April 24 letter to Rep. Carter, ADA President Gary L. Roberts and Executive Director Kathleen T. O'Loughlin thanked the congressman for his support. They also said the ADA disagrees with NADP because the ADA believes it is in the public's interest to oppose noncovered services provisions for reasons that include:

  • Imposing discounts on providers for services an insurance company doesn't cover is a marketing ploy, designed to gain a competitive advantage over smaller carriers.
  • The larger plans are using their "monopsony" market power to dictate pricing on services for which they bear no financial responsibility.
  • There is no empirical evidence that noncovered services provisions benefit the individuals covered by the plan, but they do have a negative impact on those paying out of pocket for their care. According to the ADA Health Policy Institute, the average net income for a general practice dentist in 2014 was at a level comparable with that in 1997.
The NADP also stated: "Dentists have agreed to a fee schedule and in return they receive an opportunity to reach an abundance of new clients, and therefore should not be able to circumvent certain contractual obligations of providing additional discounts."

The ADA disputed this, saying, "payer contracts are between unequal partners and thus always one-sided. While payers make many demands of dentists, including requiring them to assent to heavily discounted fee schedules, they do not assume responsibility of assuring 'an abundance of new patients' in their contract with the dentist."

"In fact, more than one in three adults, ages 19 through 64, with private dental benefits did not have a single dental claim in 2013," the Association noted.

The ADA also pointed out that there was a 10.4 percent reduction in national payment rates provided to dentists through private dental benefit plans between 2005 and 2014 with a strong correlation (0.77) between dentists' participation in preferred provider organization networks and payment rate changes, demonstrating the "payers' ability to effectively control reimbursement rates."

Other claims made by NADP include:

  • Reimbursement rates. NADP argues that "provider and carriers negotiate reimbursement rates and if they are unacceptable, dentists "do not need to join the network." The ADA asserts that this merely seeks to ensure a plan will not be able to give a "covered service" status by offering a nominal reimbursement and "does not really provide dentists with a meaningful choice when asked to make a business decision on whether to sign a contract. As payers steer more patients into using network providers, the small businesses become even more sensitive to discounts."
  • The bill only allows for reimbursement rates to be changed with an agreement signed by the provider. NADP argues that "when the new fee schedule comes out that the dentist has an 'opportunity' to assent to the new fee schedule, negotiate new fees within the schedule, or leave the network."  The ADA says this "assertion by NADP is false. Dentists do not currently have this opportunity, and as small business owners they should be able to fully evaluate the effects of modified fee schedules on their practices before agreeing to continue the contractual relationship."
  • The bill requires prior acceptance by the provider of any extension to a provider contract for limited scope dental and vision plans beyond two years. NADP argues that "the only terms of the contract that change with any frequency are fees and reimbursement rates. The additional expense for re-contracting every two years only adds cost without benefit to the consumer." The ADA counters that "the bill does not require" that re-contracting take place. The Association also disputes NADP's claim that the only terms of the contract that change with any frequency are fees and reimbursement rates, pointing out that "dentists are often contractually obligated to abide by the payers' processing policies which are usually independent documents posted on the payers' websites that are revised annually."
"Dentists, their patients, and the public at large are disadvantaged by the negative impact noncovered service provisions have on competition among entities in the health insurance industry," the ADA concluded. "The large number of states that have already passed noncovered services legislation demonstrates the need for the federal government to take action on this matter. The passage of H.R. 1606 would foster competition in the insurance industry, benefit consumers and bring balance to contract negotiations that are currently skewed unfairly to advantage dental insurance companies."

The ADA also sent the letter to House Committee on Energy and Commerce Chair Greg Walden, R-Ore., and Ranking Member Frank Pallone, D-N.J.

Read the entire letter here.

Follow all of the ADA's advocacy efforts at