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Senate introduces bill prohibiting noncovered services in dental, vision plans

ADA offers support for DOC Access Act

November 13, 2020

By Jennifer Garvin

The ADA is supporting a new Senate bill that would prohibit noncovered service contract provisions in dental plans.

In a Nov. 13 letter to Senators Joe Manchin, D-W.V., and Kevin Cramer, R-N.D., the ADA thanked the lawmakers for sponsoring S 4894, the Dental and Optometric Access Act, or DOC Access Act.

“We offer our strong support for this bipartisan legislation as we believe that patients are adversely affected by provisions in dental insurance plans that dictate what a doctor may charge a plan enrollee for services not covered by the plan,” wrote ADA President Daniel J. Klemmedson, D.D.S., M.D., and Executive Director Kathleen T. O’Loughlin, D.M.D.

If enacted, the bill would ban noncovered service contract provisions in dental and vision plans.

“It is unreasonable for dental plans to set fees for services in which the plans have no financial liability, and that is why 40 states have enacted laws that limit interference with the doctor-patient relationship when the doctor delivers services insurers do not cover,” Drs. Klemmedson and O’Loughlin wrote. “However, a federal effort is needed as many dental plans are regulated on the federal rather than state level.”

Drs. Klemmedson and O’Loughlin noted that the current landscape adversely impacts competition in the dental plan market, which “is dominated by only a few national carriers 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.” They also said the DOC Access Act 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,” Drs. Klemmedson and O’Loughlin wrote.

“Passage of [the DOC Access Act] would balance the scales and bring equity to insurer/provider contracting at the federal level. On behalf of our members and their patients, we would like to thank you again for introducing the bill,” the letter concluded.

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