Insurance

About 173 million Americans utilize dental insurance to get the oral health care they need. Unfortunately, unfair practices have crept into the administration of dental benefit plans. The AGD is working with legislators to eliminate insurance issues such as fee capping, unfair pricing, and regulations that limit consumers’ ability to utilize their benefits. 

Fee Capping: Several major dental benefits carriers set fees for dental services that are not covered under their plans. However, some states have introduced legislation to prohibit this practice, also known as fee capping.

Carriers maintain that holding dentists to a maximum charge for non-covered services allows patients to receive procedures that they otherwise might not seek. However, fee capping disrupts long-standing patient-dentist relationships and forces private-pay patients to absorb the additional costs incurred by the dentist. This practice also relieves carriers’ obligation to provide coverage for a wider range of services, which ultimately would improve access to care. 

Dentists and patients should be allowed to agree on payment terms that fit the patient’s needs while allowing the dentist to operate a successful practice and provide the best possible care. The AGD has been collaborating with the American Dental Association and other organizations to support legislation preventing fee capping. While these efforts have proven successful in some states, these states do not have jurisdiction over all dental benefits carriers, so organized dentistry must pursue solutions at the national level, as well. 

Dental Insurance Fairness Act: Some dental insurance guidelines prohibit secondary plans from covering the cost of care. As a result, families with two dental insurance plans end up paying for coverage they can’t use when they need it. 

H.R. 1798, the Dental Insurance Fairness Act of 2013, aims to ensure that patients receive the full value of their dental benefits. Introduced by U.S. Rep. Paul Gosar (R-Ariz.) on April 26, 2013, the legislation would amend the Employee Retirement Income Security Act of 1974, ensuring patients may use both primary and secondary policies to cover dental care costs. The bill, which is currently with the House Education and the Workforce Committee, also would allow consumers to avoid long reimbursement periods by assigning dental plan payments to out-of-network providers. After the 2014 Hill Day, at least one new legislator has signed on to be a co-sponsor to H.R. 1798.

Read about AGD's "Asks" on ERISA Reform while in Washington, DC April 8, 2014.

McCarran-Ferguson Act:Gosar also sponsored House Bill 911, the Competitive Health Insurance Reform Act of 2013. This legislation, introduced on Feb. 28, 2013, would repeal the portions of the McCarran-Ferguson Act that exempt health and dental insurance plans from federal antitrust laws. This would allow federal agencies to investigate and challenge collective action by insurance companies, and enable those impacted by illegal practices to take corrective action. By curtailing anti-competitive practices in the health insurance industry, H.R. 911 would promote a greater range of options for patients and more appropriate reimbursement rates for health care providers.

In the absence of federal oversight, regulation of the insurance industry will remain the states, which often lack the time and resources to effectively investigate antitrust claims, leaving anti-competitive activities largely unchecked. This must change, because competition is necessary for innovation and fosters variety in the marketplace.

The AGD urges lawmakers to support efforts to repeal the McCarran-Ferguson Act. This is an important step toward bringing competition to the health insurance market, where there is no place for anti-competitive abuses.