With pending legislation on health care price transparency potentially moving in Congress, the ADA is urging lawmakers to make adjustments to the proposed transparency requirements in the bill to account for the unique structure of dental benefits, emphasizing that patient-specific benefit information provides the clearest picture of patients' out-of-pocket costs. In a July 1 comment letter to the Senate Health, Education, Labor and Pensions Committee, the ADA advocated building  upon the bill’s transparency objectives by providing additional patient-specific benefit and payment information required to offer accurate and meaningful price transparency patients deserve.  

“The ADA supports meaningful transparency that helps patients understand their expected costs, allows employers and plan sponsors to evaluate the value of coverage, and improves accountability for health plans and third-party administrators,” reads the letter signed by ADA President Richard Rosato, D.M.D. and Executive Director Nader Nadershahi, D.D.S.. “For dental care, transparency is most effective when it is payer-facing, patient-specific, available in real time, and tied to the Code on Dental Procedures and Nomenclature.” 

According to the ADA, dental plans rather than dental practices control many of the factors that determine a patient's financial responsibility, including benefit design, deductibles, annual maximums, frequency limitations and adjudication rules. The Association said dental offices use what information is available to provide treatment cost estimates; however, dental plans should remain responsible for the accuracy of coverage estimates and payment determinations. 

The letter also recommends that routine dental imaging be excluded from the bill's imaging price transparency provisions.  

The letter recommended establishing dental-specific standards for explanations of benefits. According to the ADA, current dental explanations of benefits often rely on proprietary payer codes that make payment decisions difficult for both providers and patients to interpret. The Association urged the Department of Health and Human Services to work with the ADA and standards organizations to establish dental-specific explanation of benefits content and format requirements built around CDT Codes and existing dental transaction standards. 

“The ADA welcomes the opportunity to work with the Committee on ways to enhance the strongest parts of the Patients Deserve Price Tags Act while avoiding unintended burdens on dental practices and their patients,” the letter concluded. 

For the latest advocacy efforts on insurance reform visit ADA.org/advocacy.