Third Party Coverage
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At Issue
Associated medical cost laws refer to the requirement that medical plans pay for hospitalization and related medical expenses, such as the administration of general anesthesia, when dental treatment is best performed in the hospital (some state laws allow payment for medical expenses incurred when treatment is performed in the dental office).
Some states have adopted legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. Because TMD is a significant health condition requiring intervention by a licensed dentist and/or physician, insurance companies are strongly encouraged to offer and coordinate benefit coverage for diagnosis and treatment of temporomandibular bone and joint disorders.
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ADA Priorities
- Coverage for Treatment of Temporomandibular Joint Dysfunction - ADA Policy (1989:549) The American Dental Association encourages all third-party payers to offer benefit coverage for diagnosis and treatment of bone and joint disorders without discrimination, and that all third-party payers coordinate the coverage between medical and dental plans to eliminate any disparity in benefits coverage and reimbursement for such disorders.
- 2006 ADA Resolution 58H - Insurance Benefits for Necessary Dental Treatment of Certain Medical Conditions
Directs the ADA to seek changes in federal statutes dealing with ERISA, and urges constituent dental societies to advocate for state laws requiring that dental treatment, which is integral to the treatment of a diagnosed medical disease, be afforded coverage under the third-party medical payer’s contract.
- 2006 ADA Resolution 60H - Medically Necessary Care Consensus Statement
Calls for the ADA to develop a consensus statement by working with national medical associations and dental specialty organizations that validates the need for medical insurance coverage for medically necessary services associated with dental treatment, especially for care for children, the elderly and patients with disabilities.
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Additional Resources
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Contact Us
For additional information, please contact:
Federal Affairs
1111 14th Street NW, Suite 1100
Washington, DC 20005
202-898-2400
Fax: 202-898-2437
E-mail: govtpol@ada.org
State Government Affairs
ADA Chicago Headquarters
211 East Chicago Avenue
Chicago, IL 60611
312-440-2525
Fax: 312-440-3539
E-mail: govtpol@ada.org
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