Rhode Island law bans insurers rate caps on noncovered services

Providence, R.I.鈥擜 bill passed in Rhode Island last month will prevent dental plans there from capping the amount dentists can charge for services the plan doesn’t cover.

“We’re very proud,” said Dr. Frank Connor, president of the Rhode Island Dental Association. “We got the job done by doing what we had to do鈥攚orking through the state legislature.”

Rhode Island legislators unanimously passed mirror bills in the state House of Representatives and Senate applying the law to any dental plan operating in the state.

“No contract between a dental plan of a health care entity and a dentist for the provision of services to patients may require that a dentist provide services to its subscribers at a fee set by the health care entity unless said services are covered services under the applicable subscriber agreement,” the bills say in part.

Dental plans began implementing contract provisions holding dentists to maximum allowed fees for services on patients’ out-of-pocket billings with increasing frequency last year. Delta Dental then projected such a provision would be phased in throughout the country by January 2011.

“Obviously we can’t go against state legislation,” Tom Dolatowski, Delta’s vice president of marketing and communication, said about how Delta’s national phase-in plan would change as a result of the legislation. “The potential always exists for the provision to be determined on a state-by-state level.”

It was聽an article in the Sept. 15, 2008, ADA News that alerted Rhode Island members to the issue and got the RIDA initiative off the ground, said Patrick Quinlan, RIDA lead counsel and lobbyist.

“A copy of the ADA News article and the contract provision was distributed to educate members,” said Mr. Quinlan. “Dentists wrote to their legislators and attended fund raisers to meet them. As soon as legislators learned about the issue, they ‘got it.'”

Scheduled for implementation in January 2010, Delta’s noncovered services provision would have affected more than 90 percent of Rhode Island dentists.

The Council on Dental Benefit Programs has prioritized the noncovered services issue among the “Top Ten” member dental benefit concerns. CDBP’s Dental Benefit Information Subcommittee plans to meet with major carriers to discuss such issues at the upcoming National Dental Benefits Conference at ADA Headquarters next month.

“The Council has been collecting and analyzing this information from the point it initially surfaced. We have been closely monitoring the developments as they transpired and we have shared our concerns,” said Dr. Joseph Hagenbruch, CDBP chair. “We have articulated our recommendations and look forward to supporting the advocacy efforts of the ADA Council on Government Affairs as they draft legislation similar to that recently enacted in Rhode Island.”

The CGA has drafted proposed federal legislation that would get directly at the issue for ERISA plans (federally regulated plans). State legislatures cannot effect changes to ERISA. The Employee Retirement Income Security Act of 1974 is a federal law that sets minimum standards for retirement and health benefit plans in private industry.

“This issue, as well as other third-party concerns, is on our radar screen,” said Dr. Joseph Crowley, CGA chair. “Members can expect some legislative activity at the federal level soon.”

The July 14, 2008, ADA News featured an article in point-counterpoint style including perspectives from ADA members, National Association of Dental Plans members and the CDBP on provider contract issues, including noncovered services. Interested dentists can link to聽articles about dentists’ top ten dental benefit concerns on ADA News Today at ADA.org.