More states enact dental insurance legislation

Pennsylvania, Illinois pass virtual credit card, prior authorization bills

Two states have enacted new dental benefit laws, both of which have been supported by the ADA’s State Public Affairs program. 

Pennsylvania passed legislation that prohibits dental insurers from adopting a policy of paying participating dentists using only virtual credit cards, while Illinois passed legislation on prior authorization and requiring health insurers to cover medically necessary care and treatment for significant jaw injuries caused by accident or disease. Pennsylvania and Illinois join Arizona, Florida, Indiana, Iowa, Louisiana, Maryland, Missouri, Ohio, Rhode Island, Tennessee and Virginia in recently passing dental benefit legislation. 

Both states used SPA grants to build support for their campaigns. The ADA founded its SPA program in 2006 to help state societies manage specific legislative and public affairs matters, and it has since evolved into a valued resource for state dental societies by helping to add capacity to their lobbying, communications and public affairs efforts. 

Pennsylvania passed House Bill 1664, which prohibits dental insurers from limiting claim payment methodology to only virtual credit cards. Dental insurers are now required to provide notice to participating dentists of all the payment options, in addition to instructions and contact information for dentists to obtain the exact fees imposed by the insurer or its contracted vendors. 

Darleen Oleski, D.M.D., chair of the Pennsylvania Dental Association’s government relations committee, said passing virtual credit card legislation was a “hard-fought victory” especially considering Pennsylvania leans heavily in support of the insurance industry. 

“After months of negotiation with dental insurers, credit card companies and their contracted vendors, [the Pennsylvania Dental Association] succeeded in passing a commonsense policy related to payment of dental claims. Enhanced transparency and payment options give dentists the ability to make informed decisions that work best for their practice," she said. 

Illinois passed House Bill 4789, which ensures companies stick to their prior authorizations, and Senate Bill 3305, which secures insurance coverage for jaw injury treatments. 

Specifically, under HB 4789, insurance companies cannot deny any claim subsequently submitted for procedures specifically included in a prior authorization unless certain circumstances apply. SB 3305 requires health insurers to provide coverage for medically necessary care and treatment for a major injury to the jaw either through an accident or disease.

“[SB 3305] started when an Illinois resident undergoing treatment for jaw cancer required extensive reconstructive surgery and dental implants. The individual had these services denied by the insurance company. Under the new law, individual and group insurance policies must cover medically necessary treatments for major jaw injuries, including oral and facial surgery, dental implants, prosthetics, and other essential treatments,” said Lindsay Wagahoff, director of government relations at the Illinois State Dental Society. 

To learn about the other states that passed dental benefit legislation in 2024, read this ADA News story. 

Follow all the ADA’s advocacy efforts at ADA.org/Advocacy.