ADA, National Council of Insurance Legislators push for transparency in dental insurance bills

Dr. White

Supported by the ADA, the National Council of Insurance Legislators adopted its Transparency in Dental Benefits Contracting Model Act at the end of 2020. It ended up serving as the impetus for myriad state bills in the 2020-21 legislative session that underscore the need for transparency when it comes to dental insurance.

In all, 15 states pursued aversion of the NCOIL model legislation during the 2020-21 legislative session. Out of that effort, so far, 13 new laws were enacted in 11 states.

During the drafting discussions of the model legislation, NCOIL heard from a wide array of interested parties, including the ADA, about the bipartisan dental benefits model being used as a template for introducing similar legislation around the country.

The approved model legislation was circulating among the states throughout the 2021 legislative session, with the ADA investing a lot of time — over a year — and energy getting NCOIL to adopt the model, according to David White, D.D.S., chair of the ADA Council on Government Affairs.

Dr. White added that a little over a decade ago, the National Council of Insurance Legislators adopted a model law on noncovered services for dental plans, and as of today, over 40 states have a noncovered services law enacted, with many of these adhering closely to the organization’s legislative language.

The more recent model legislation addresses three critical reform issues trending in state legislatures nationwide. The legislation:

  • Requires fair and transparent network contracts.
  • Prohibits dental benefit plans from denying any claim subsequently submitted by a dentist for procedures specifically included in a prior authorization unless an exception applies for each procedure denied.
  • Prohibits dental benefit plans from restricting the methods of payment from the dental benefit plans or its vendor or the health maintenance organization to the dentist in which the only acceptable payment method is a credit card payment.

“The model language on these three issues offers a balanced approach, empowering all three stakeholders in the dental transaction – patients, dentists and insurance carriers – in a way that supports access to care and needed clarity in how dental benefits are paid,” according to a letter the ADA and other dental groups sent the National Council of Insurance Legislators ahead of its December 2021 meeting.

“These issues are very important to me as I have seen how if left unchecked, the practices that the model addresses can harm both patients and dentists,” said Deborah Ferguson, D.D.S., vice chair of the NCOIL Health Insurance & Long Term Care Issues Committee, in a news release issued by NCOIL. “I am confident that this model provides for the ultimate level of transparency. Transparency in dental insurance and dental care is of the utmost importance for the dentist, but 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 main area of public policy concern is insurance legislation and regulation. Many legislators active in NCOIL either chair or are members of the committees responsible for insurance legislation in their respective state houses across the country.

NCOIL CEO Tom Considine, J.D., said in the news release that the model came a long way from when it was first introduced, due in large part to the leadership of (former NCOIL President) George Keiser and Dr. Ferguson.

“As sponsors, they were able to guide the conversations to a point where sufficient consensus could be reached so the model could be adopted and presented to states for consideration,” Mr. Considine said. “Everyone had the same goal of ensuring that people have access to affordable and quality dental care, and this model highlights the importance of that.”

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