September 30, 2021
Supported by the ADA, the National Council of Insurance Legislators adopted its Model Law on the Transparency of Dental Services Contracts at the end of 2020. It ended up serving as the impetus for a myriad of state bills in the 2020-21 legislative session that underscore the need for transparency in dental insurance.
A total of 15 states – 16 if Michigan tables its leasing bill – passed a version of the NCOIL model law during the 2020-21 legislative session. On this effort, so far, 13 new laws have been enacted in 11 states.
During the drafting discussions of the model legislation, NCOIL heard from a wide range of stakeholders, including the ADA, about the bipartite model of dental benefits being used as a model for the introduction of similar legislation across the country. country.
The approved model legislation circulated among states throughout the 2021 legislative session, with the ADA investing significant time – over a year – and energy to get NCOIL to adopt the model, according to David White, DDS, Chairman of the ADA Council on Government Affairs.
Dr White added that a little over ten years ago the National Council of Insurance Legislators adopted a model law on uncovered services for dental plans and that to date more than 40 states have enacted a law on uncovered services, many of which adhere closely to the legislative language of the organization.
The most recent model legislation addresses three critical reform issues facing state legislatures nationwide. The legislation:
• Demands fair and transparent network contracts.
• Prohibits dental plans from refusing any claim subsequently submitted by a dentist for procedures specifically included in a prior authorization, unless an exception applies for each procedure refused.
• Prohibits dental plans from restricting methods of payment from dental plans or their provider or health maintenance organization to dentists for whom the only acceptable method of payment is payment by credit card.
“The model language on these three issues offers a balanced approach, empowering all three stakeholders in the dental transaction – patients, dentists and insurance companies – in a way that promotes access to care and the necessary clarity in how whose dental benefits are paid, “according to a letter the ADA and other dental groups sent to the National Council of Insurance Legislators ahead of its December 2021 meeting.
“These issues are very important to me because I have seen how, if left unchecked, the practices addressed by the model can harm both patients and dentists,” said Deborah Ferguson, DDS, vice president of the NCOIL Health Insurance and Long Term Care Issues Committee. , in a Press release issued by NCOIL. “I am convinced that this model offers the ultimate level of transparency. The transparency of dental insurance and dental care is of the utmost importance for the dentist, but even more so for the patient, as they end up absorbing unnecessary costs.
The National Council of Insurance Legislators is an organization of state legislators whose primary area of public policy concern is insurance law and regulation. Many legislators active at NCOIL chair or are members of the committees responsible for insurance legislation in their respective state houses across the country.
NCOIL CEO Tom Considine, JD said in the press release that the model has come a long way since its introduction, thanks in large part to the leadership of (former NCOIL chairman) George Keizer and Dr Ferguson.
“As sponsors, they were able to steer the conversations to a point where sufficient consensus could be reached so that the model could be adopted and presented to states for consideration,” Considine said. “Everyone had the same goal of ensuring that people have access to affordable, quality dental care, and this model underscores the importance of that. “