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ADA has resources to help state societies draft legislation

August 27, 2018

By David Burger

Editor's note: This is the 17th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.

It's all about not having to reinvent the wheel.

Photo of Dr. Kessler
Dr. Kessler

Whether the issue is disallowed clauses or delayed refund requests, many problems faced by dentists every day can be addressed by state dental societies in their legislative efforts, according to Dr. Brett Kessler, member of the ADA Council on Dental Benefit Programs.

The ADA recognizes this, so the Council on Dental Benefit Programs has a webpage devoted to Principles for Model Legislation for state dental societies to use as they see fit.

All of the principles are written broadly so that each state can tailor to their needs.

"The ADA works tirelessly to influence public policies affecting the practice of dentistry and the oral health of the American public," Dr. Kessler said. "In Washington, D.C., and in state capitals, the ADA lobbies legislatures, Congress, the Administration — fighting for things that matter to dentists and the patients they serve. And the ADA also provides technical support to help state dental societies advance their respective policy agendas. And that's an important member benefit, because those policies affect every dentist in every practice — and ultimately every patient."

The model legislation is available at ADA.org/en/advocacy/principles-for-model-legislation.

This resource is there, ready to go, when the issue arises. Like a fire department, the ADA doesn't want to wait until there's a fire to cobble together resources — it needs to have them ready for when the fire happens.

One example of model legislation is language to address the withholding of benefits from one dentist because of overpayment to another dentist or based on another patient's account.

To aid state dental associations considering legislation to address this issue, the ADA has identified concepts that could be included in state legislation. The concepts are:

  • Any contract providing benefits for dental care, shall not withhold payment to a dentist because of an alleged overpayment to another dentist.
  • Also, the plan shall not withhold payment to a dentist because of an alleged overpayment to the dentist based on another patient's account.

DDB LogoIn another example, the ADA has heard from dental offices that dentists have been asked to refund payments to a plan because of an alleged overpayment to the dental office. Sometimes these requests are sent up to two years after the patient was treated. This can create accounting difficulties for dental offices and it is also very difficult for dentists to obtain payment from the patient after such a long period of time has elapsed.

In response, the ADA Council on Dental Benefit Programs has drafted language for legislation to address the issue.

These were just two of the scenarios the ADA Council on Dental Benefit Programs has written model legislation about. Other issues concern affiliate carrier clauses; medical loss ratio; dental designation; inadequate notice to providers when carriers change policies; deferred compensation programs; and transparency in third-party payment transactions, among others.

In addition, the ADA Department of State Government Affairs offers resources to help state and local dental societies benefit from the best practices and lessons learned in other states and municipalities. For additional information or to request assistance, contact the department at 1-312-440-2525 or govtpol@ada.org.

One state where the ADA aided successful legislative efforts is Louisiana. A new law in the state, effective Jan. 1, 2019, prohibits dental carriers from denying any claim for a procedure where the insurer has issued a prior authorization. Ward Blackwell, Louisiana Dental Association executive director, said the ADA provided support by helping draft amendments that moved the bill toward becoming law.

Follow ADA advocacy at ADA.org/advocacy.

The ADA has also created an online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions. Go to ADA.org/dentalbenefits, part of the ADA Center for Professional Success.

Staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org.

Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.