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ADA comments on surprise billing

Letters urge Congress not to include dental offices in legislation

February 13, 2020

By Jennifer Garvin

Washington — The American Dental Association is weighing in on two pieces of legislation aimed at streamlining billing procedures for patients.

In Feb. 11 letters to the U.S. House Committee on Ways and Means and House Committee on Education and Labor, the Association has asked lawmakers to clarify the definition of a health care facility in HR 5800, the Ban Surprise Billing Act, and HR 5826, the Consumer Protections Against Surprise Medical Bills Act.

ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin noted that previous surprise billing legislation has focused on emergency services and elective surgeries where patients believe their procedures took place in their health insurance networks only to receive unexpected bills after the fact. They noted that the Association believes this is an appropriate way to approach such legislation because it does not interfere with nonemergency services, such as routine dental office visits since dental insurance is “generally a defined benefit with limitations such as very small annual maximums.”

Regarding HR 5826’s requirements on good faith estimates, Drs. Gehani and O’Loughlin said, “Routine dental exams can provide an opportunity to address other issues as they arise and if an estimate is mandated for dentists, this could become a costly and administrative burden for dentists while putting dentists between the patient and insurance company. Often, dentists will not know what the final cost to a patient will be until after an insurance company has reviewed and paid the claim, which can take more than 30 days.”

In response to HR 5800, the ADA pointed out that oral and maxillofacial surgeons are “an integral part of hospital systems and ambulatory surgical centers and perform complex procedures at hospitals, provide emergency department coverage, and are members of trauma teams.” Because of this, both the ADA and American Association of Oral and Maxillofacial Surgeons “support the draft legislation’s efforts to prohibit patients from being billed beyond the in-network rate when provided emergency care by out-of-network providers at in-network hospital and ambulatory surgical facilities when adequate consent is not given.”

Follow all of the ADA’s advocacy efforts at ADA.org/advocacy.