VIRGINIA DENTISTS BLOCK FEE CAPPING - 03/15/2010
On Friday, February 26, 2010, the Virginia Dental Association (VDA) joined the ranks of the Rhode Island Dental Association by successfully blocking fully insured dental plans from capping fees on noncovered dental services in their state. Virginia Senate Bill 622 passed unanimously, and House Bill 1263 passed 92-4.
Although several dental networks have already restricted fees for noncovered services (e.g., Aetna, United Concordia, and approximately half of all Delta Dental plans), allowable fees for noncovered services erupted into a volatile issue nationwide recently as the ADA and several state dental associations finally put their foot down in response to the Delta Dental Plans Association (DDPA) announcement last year that all Delta Dental plans would cap fees for noncovered services by January 1, 2011.
Dentists challenged why insurance companies should have a say in the fee a dentist charges if they are not paying the claim, especially since PPO fees are often imposed, rather than negotiated. Dental associations across the U.S. are joining the charge to oppose fee capping for noncovered services, feeling it will shift costs to the uninsured, the group that can afford dental services the least. According to the American Dental Association, a growing number of states are considering similar legislation, including: Alaska, Arizona, Colorado, Hawaii, Illinois, Indiana, Iowa, Kansas, Maryland, Mississippi, Missouri, Nebraska, Oklahoma, Oregon, Pennsylvania, South Dakota, and Washington.
Fully-insured vs self-funded dental plans
It is important to remember that state insurance laws seldom apply to self-funded dental plans. Although Rhode Island and Virginia now have laws preventing dental plans from capping fees for noncovered services, these laws only apply to fully insured plans licensed in those states. Self-funded dental plans are regulated by the U.S. Department of Labor under ERISA (Employee Retirement and Income Security Act of 1974). To address this issue, which affects a large percentage of the dental plans in existence today, the ADA is pursuing an “aggressive lobbying stategy” for ERISA reform and noncovered services legislation (ADA News (Feb 18, 2010).
How many patients exceed their annual maximums?
According to Michael Weitzner, DMD, MS, Vice President of National Clinical Operations for United Healthcare (UHC), only 5% of patients covered by UHC reach their maximum in a benefit year, and 75% of patients covered by UHC use less than $500 per benefit year. These estimates are consistent with those cited by other dental insurance carriers.
Restricting fees for noncovered services appears to be the bigger problem, impacting the fees participating dentists can charge for implants, bleaching, occlusal guards, cosmetic veneers, posterior composites, sealants, etc.
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DELTA DENTAL CLARIFIES LASER POLICY - 08/02/2010
An increasing number of dentists are using lasers to perform sulcular debridement (curettage) and ot ...more
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Thank you again for your help. Insurance Solutions has never let me down when it comes to questions being answered. It is so nice to have a resource as helpful as you!
Thanks,
Jessica Linde
Office Manager River Valley Dental
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CDT 2011/2012
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Coding Workshop
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