December 10, 2012
Councils take on noncovered services bills
This year, legislators in 12 states filed noncovered services bills and three states have enacted a law—Pennsylvania, Illinois and Kentucky.
Additionally, Nebraska and Mississippi enacted laws to enhance their existing noncovered services statutes.
Crafting legislation that prohibits insurance companies from controlling what a dentist may charge for services dental benefit plans don’t cover is no easy feat.
It takes teamwork between state dental societies and legislators who are championing the law and cooperation between the ADA Council on Dental Benefit Programs and Council on Government Affairs.
CDBP staff and council members come in handy when state dental society leaders are negotiating the terms of the law and how various aspects of it should be defined.
“The ADA’s State Government Affairs department keeps state dental leaders apprised of what bills are introduced, what laws are on the books and the nuances of each. Through regular email updates, we help state leaders learn what other states’ challenges are with respect to the definition of covered services,” said Dr. Henry Fields, CGA chair. “The expertise of CDBP staff helps us help the states properly define the various coverage mechanisms so that the noncovered services law has a comprehensive and useful impact.”
The two councils also work together on assignment of benefits and coordination of benefits laws. The ADA is committed to assignment of benefits laws that prevent dental plan contracts from refusing to honor the patient’s option to have the dentist paid directly by the plan.
The ADA supports coordination of benefits laws that require the primary payer to pay its normal benefit and the secondary plan pay what it would have paid had it been primary up to the doctor’s full fee when two plans cover the same procedure or claim.
The more expertise there is in this process, the more successful states will be adopting laws to help patients utilize dental benefit plans to maintain and improve their oral health, Dr. Fields said.
“That’s the benefit of having this kind of cooperation,” Dr. Fields said. “The noncovered services advocacy effort is a primary example of legislation that’s gradually gained momentum nationwide. We’re more sophisticated and successful than if everybody was going at it alone.”