ADA News

Dr. May

Pennsylvania is the latest state to enact noncovered services legislation, bringing the total number of states with laws on the books to 29.

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.

Dr. Fields

“Each of the councils has a unique perspective and can lend a hand to specific parts of the process,” said Dr. David May, CDBP chair. “While CGA members and staff are fluent in the legislative wording and the best ways to get bills through state legislatures, CDBP staff and council members can provide expertise on defining various benefits terms and context on why it’s important to dentists for this legislation to pass.”

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.”