Noncovered service caps legislation at issue in Virginia
Richmond, Va.鈥擠entists and insurers are at odds in the commonwealth over noncovered services, each vying for public attention over legislation offered in the general assembly at Virginia Dental Association request.
“The VDA initiated this legislative action out of deep concern for our patients and the future of our profession,” said Dr. Alonzo Bell, VDA president. “If insurance companies are allowed to set the fees for services they pay nothing for, it will drive up the costs of quality dental care for those who can least afford it, namely the 50 percent of Virginians who have no dental benefits.
“Simply put, we believe it is unfair to allow a few insurance companies to pad their ever increasing profits by shifting costs to patients without dental benefits and to those patients insured by other companies,” said Dr. Bell, an Alexandria general practice dentist. If “these tactics” are successful, he said, it could lead to insurer control of all fees for dental services.
“One of the concerns we have, not only from our standpoint but the patient’s standpoint, is that insurance companies are implying that the profession of dentistry doesn’t care about the benefits you get from your insurance plans,” Dr. Terry Dickinson, VDA executive director, says in a video posted at the association Web site www.vadental.org. “They say they care. We say we care.”
The online battle for the hearts and minds if not the pocketbooks of Virginians heated up with an insurer-labor coalition charging in a Web advertisement at www.vdawantsyoutopaymore.com that “Many Virginia residents who have dental insurance will pay more out of their own pockets if two bills introduced in the 2010 General Assembly (SB 622 and HB 1263) pass.”
The state dental association posted the coalition ad at www.vadental.org and invited VDA members to “Read What Delta is Saying About the VDA” and “act NOW” in urging legislators’ support for the legislation (see related article below). The VDA also went public in video and other online messages “To the Citizens of Virginia & the Virginia General Assembly On behalf of Quality Dental Care, Patient’s Rights and Free Market Competition.
“Big insurance has the clout to cap fees, but when the end result is cutting corners鈥攑atients suffer鈥攄entistry suffers鈥攐nly the insurance company will profit,” VDA Online says at its public access site. “Now insurance companies want to fix prices on services they won’t even pay for.”
The issue, as framed by the VDA, is this: “Some dental insurance companies are seeking to mandate fees for procedures that they are not paying for. The dental insurance companies are amending their contracts or putting new contracts in front of dentists that set the fees dentists can charge not only for covered procedures, but also for those procedures not covered by the policy.”
The “Coalition for Affordable Care” lists 23 insurance, labor union and business “partners” as opposing the VDA legislation. The coalition invites visitors to “check back every few days to see the names of additional groups who understand that this legislation has no place being introduced at all, much less in this economy.”
The VDA counters that “this new attempt to fix prices will hurt the citizens of Virginia by stifling quality measures and advancements in patient care. For this reason a new law has been proposed in the Virginia legislature to prevent insurance companies from abusing their clout and expanding their price fixing practices.”
The issue is resonant among states and in ADA policy.
At least seven states have filed legislation to restrict an insurance company’s ability to require contracting dentists to limit their fees on services the company doesn’t cover, and upwards of 20 other states are considering legislation; (see also 07/07/2009 reports on Rhode Island law at www.ADA.org).
American Dental Association policy adopted by the 2009 House of Delegates seeks legislative action to prevent dental plans from capping the amount that dentists can charge for services a plan doesn’t cover (ADA News Today 11/12/2009, Noncovered services: House supports legislative action to counter trend).
Legislation in Virginia
Richmond, Va.鈥擫egislation offered in the 2010 General Assembly at Virginia Dental Association request would prohibit insurance plan capping of dentists’ fees for services the plan doesn’t cover.
“We need your help,” the VDA said in a member message at www.vadental.org. “As you are most likely aware, some dental benefits carriers are mandating/limiting fees for non-covered services. A resolution was passed at this year’s VDA House of Delegates meeting to introduce legislation that would disallow this practice by insurance companies.
“Please contact your state delegate and senator and educate them about the bill,” says the VDA Online message.
Companion House and Senate bills, “Dental plans; reimbursement for health care services,” would “prohibit(s) a contract for the provision of health care between a dental plan and a dentist or oral surgeon that establishes the fee or rate that the dentist or oral surgeon is required to accept for the provision of health care services, or from requiring that a dentist or oral surgeon accept the reimbursement paid by the dental plan as payment in full for health care services.
“These prohibitions do not apply to covered health care services that a dentist or oral surgeon has agreed to provide on behalf of the dental plan to its insured, subscribers, or enrollees with an expectation of receiving payment, other than copayments or deductibles, directly or indirectly from the dental plan. The measure applies to contracts entered into, amended, extended, or renewed on or after July 1, 2010.”
The General Assembly was in session in late January when the VDA said the Senate was expected to “take up this measure in the next one-to-three weeks.” SB 622 and HB 1263 were referred to the respective Commerce and Labor Committees.