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Federal legislation would bar dental, vision plans from setting fees for noncovered services

July 18, 2019

By David Burger

Washington — The Dental and Optometric Care Access Act was reintroduced in the U.S. House of Representatives July 15, proposing federal legislation that would prohibit dental and vision plans from setting fees for noncovered services.

The bill, H.R. 3762, also called the DOC Access Act, is supported by the ADA and American Optometric Association.

Rep. Dave Loebsack, D-Iowa, reintroduced H.R. 3762. The legislation would prohibit all federally regulated plans from mandating that dentists discount their normal fee when the fee is for a service not covered by the plan. The bill also would also prohibit plans from imposing restrictions on medical plan participation and setting limits on a doctor's choice of lab.

“The Dental and Optometric Care Access Act will help prevent dental insurance companies from interfering in the doctor-patient relationship by dictating prices for services they don't even cover,” said Dr. Jeffrey M. Cole, ADA president. “Patients and consumers will benefit from improved competition in the insurance industry when contract negotiations are unable to be skewed unfairly to advantage dental insurance companies. The passage of noncovered services legislation in many of the individual states only demonstrates the need for the federal government to finally take action on this matter to help patients across the country.”

“The DOC Access Act is critical in ensuring doctors meet patient needs,” said Rep. Buddy Carter, R-Ga., one of the cosponsors of the bill, 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 establishes some practices for provider network participation, including limiting network agreements to two years without prior acceptance of the doctor for each term extension and not restricting the doctor’s choice of laboratories.

Drs. Cole and Kathleen T. O’Loughlin wrote a letter July 16 to Reps. Loebsack and Carter to commend them for championing the legislation.

“The current landscape adversely affects competition among plans in a dental plan market dominated by only a few national players in many states, and shifts costs to patients who are paying for their coverage out of their own pockets or are seeing a dentist out of network,” wrote Drs. Cole and O’Loughlin. “H.R. 3762 will provide greater access to high-quality care by helping to curb anti-patient and anti-competitive practices of dental insurance plans. This legislation is crucial to bring needed balance to contract negotiations between providers, who are often small business owners, and large dental insurance companies. We look forward to working with you to advance this important legislation.”

Barbara L. Horn, O.D., American Optometric Association president, also thanked the lawmakers in a statement. “With Congress’ attention increasingly turning to making the cost of health care less of a surprise for American families, introduction of the American Optometric Association and ADA-backed DOC Access Act could not have come at a better time. America’s doctors of optometry applaud Reps. Loebsack and Carter for again taking the lead on this key bipartisan effort focused on reigning in costly and access-limiting vision and dental plan abuses. We’re excited to again be working with our ADA partners and we look forward to continuing to build support for this and other shared priorities, including the repeal of the health insurance industry’s antitrust exemption.”

To date, 39 states have passed legislation to limit noncovered services provisions in dental plans, Drs. Cole and O’Loughlin said. Even with state legislation, the DOC Access Act can help dentists because many insurance plans fall under the Employee Retirement Income Security Act (ERISA) and as such can claim that they are not covered by the state law.

H.R. 3762 is narrowly drawn to apply only to dental and vision plans regulated by the federal government. This legislation would not interfere with the states’ abilities to maintain and enforce their own insurance regulations and laws, as well as complement the work already done by most state legislatures across the country.

There are seven original bipartisan cosponsors of H.R. 3762, including Reps. Mike Simpson, R-Idaho, Paul Gosar, R-Ariz., Drew Ferguson, R-Ga. and Jeff Van Drew, D-N.J., all dentist and ADA members.

H.R. 3762 was referred to the House Committee on Energy and Commerce.

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