ADA highlights dental market reforms in advance of insurer CEO hearings 

Comments urge improvement of transparency, accountability, competition 

Ahead of the House Energy and Commerce Committee and the House Ways and Means Committee’s joint day of hearings Jan. 22 with chief executive officers of several large health insurance companies, the ADA submitted a comments letter urging lawmakers to use the moment to examine longstanding issues in the commercial dental market. 

“While the stated focus is overall commercial affordability, these hearings are a timely opportunity to examine market reforms that directly affect patients’ access to dental care and the ability of dentists to deliver that care efficiently and transparently,” the ADA wrote, urging the committees to use the hearings to “obtain concrete, plan-level dental information and to advance reforms that improve transparency, accountability, and competition.” 

One theme of the letter is how dental plans, as they are currently designed, shift significant costs to patients The ADA noted that common benefit designs cover preventive services at higher levels while leaving patients responsible to pay significant money out-of-pocket for major services such as crowns. According to the Association, this high coinsurance requirement, combined with low annual maximums, creates barriers that can delay or prevent needed care. 

To address affordability and oversight gaps, the ADA called on the committees to require standardized, plan-level reporting across both fully insured and Employee Retirement Income Security Act, or ERISA, self-funded dental plans. Recommended data elements include premiums, benefit design features, patient liability drivers, denial and appeal rates, and payment timeliness. The ADA also reiterated its support for transparent reporting of dental loss ratios, which would tell plan purchasers how much of their premiums are actually going to their care. 

A large part of the letter focused on ERISA self-funded dental arrangements, where carriers act as third-party administrators. In these cases, the ADA said, patients and dentists frequently cannot determine who established coverage rules or claims policies. The Association urged Congress to lift the third-party administrators’ veil by clarifying who sets coverage and payment rules and by requiring disclosure of all direct and indirect compensation and incentives tied to claims outcomes. 

The ADA also raised concerns about nonconsensual network expansion and rate leasing practices, stating that dentists should not be placed into new contractual relationships without affirmative agreement. The Association recommended policies requiring written provider consent before contracted rates are leased or repriced and clearer disclosure to plan sponsors and beneficiaries when leased networks are used. 

“Network leasing, rental networks, and repricing arrangements raise acute transparency and consent concerns in dental contracting,” the Association wrote. “We feel strongly that dentists should not be forced into new contractual relationships without affirmative agreement.”  

Additional recommendations addressed claims administration standards, including timely payment of clean claims, clearer explanations of benefit reductions, limits on post-payment recoupments and the use of licensed dentists in claims review. The ADA also urged lawmakers to protect patient freedom of choice, ensure dental networks are adequate in practice, and scrutinize benefit designs that rely on annual maximums and waiting periods. 

“The ADA appreciates the Committees’ attention to commercial affordability and urges focused oversight of the dental market, especially where vertical integration and ERISA-administered arrangements can obscure decision-making, limit competition, and shift costs to families,” the Association concluded.