ADA urges Congress to focus transparency efforts on dental benefit plans 

The ADA is urging House lawmakers to pursue health care transparency policies that strengthen accountability for insurers and Medicare Advantage plans and improve the patient experience, while avoiding requirements that it says are ill-suited to dental practices. 

In a letter submitted June 9 to leaders of the House Energy and Commerce Committee ahead of the Subcommittee on Health’s hearing, “Lowering Health Care Costs for All Americans: Examining Policies to Increase Health Care Transparency,” the ADA weighed in on several transparency-related bills under consideration. 

The Association said it supports transparency measures that help patients understand expected costs and improve oversight of health plans, but emphasized that dental benefit payers control most of the information needed to determine what patients ultimately owe. 

“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.” 

Drs. Rosato and Nadershahi expressed support for legislation that would require greater reporting on insurer overhead costs, claims payments and administrative expenses. They encouraged lawmakers to ensure that dental benefit spending is clearly reported, particularly within Medicare Advantage plans that offer supplemental dental benefits. 

The letter voiced support for provisions in the Patients Deserve Price Tags Act that would provide real-time, patient-specific benefit information to providers and patients. However, it raised concerns about applying hospital-style transparency requirements to dental practices. 

Drs. Rosato and Nadershahi said publicly posting full fee schedules, negotiated rates or other insurer-dependent pricing information would not give patients an accurate picture of their out-of-pocket costs because dental benefit plans control the coverage information needed to determine patient responsibility. 

“Because dental offices are not large institutional medical systems and the typical dental coverage plan structure is vastly different from medical plans, public posting of full practice fee schedules, payer-specific negotiated rates, minimum or maximum contracted charges or other insurer-contingent pricing information would not provide patients with a meaningful estimate of their actual out-of-pocket costs, and may in fact hinder clear pricing information,” they wrote. 

Instead, they urged lawmakers to require dental benefit payers to provide “real-time, patient-specific coverage and cost-sharing information by CDT code,” including information on deductibles, annual maximums, frequency limitations and expected plan payments. 

Beyond cost and billing transparency, Drs. Rosato and Nadershahi endorsed proposals that would increase reporting of health care ownership information. They said patients should be able to understand “who owns, controls or manages the entity through which their care is delivered” and urged lawmakers to include dental practice ownership and management arrangements in any reporting framework. 

The letter also supported measures aimed at strengthening oversight of Medicare Advantage plans. Drs. Rosato and Nadershahi encouraged lawmakers to consider how agent and broker compensation may affect the way supplemental dental benefits are marketed to beneficiaries and backed proposals to improve Medicare Advantage encounter data reporting, including information on allowed amounts and beneficiary cost-sharing. 

“The ADA supports transparency policies that improve payer accountability, strengthen MA oversight, standardize dental benefit information and give patients real-time, patient-specific cost information by CDT code,” the letter states. 

They concluded the letter by welcoming the opportunity to work with lawmakers on amendments that preserve the transparency goals of the legislation while avoiding unnecessary burdens on dental practices and patients.