Rhode Island bans fee capping for uncovered procedures

2009 02 20 17 38 08 856 Capitol Hill 70

A new law in Rhode Island prohibits insurance companies from setting the fees of dental procedures that they do not cover.

The law, which was passed June 18, is the result of legislation introduced by the Rhode Island Dental Association (RIDA) in response to a Delta Dental policy announced last year.

According to that policy, Delta Dental would implement a new feature of its premier and preferred provider organization contracts that would require dentists to honor their contracted fees for services that are not covered by a subscriber's plan.

The provision was to be introduced in a phased approach, with a national policy effective January 1, 2011.

However, the new law in Rhode Island prevents Delta Dental from implementing it in that state.

“We thought it was unfair trying to dictate fees on uncovered procedures.”
— Francis Connor Jr., D.D.S., president,
     Rhode Island Dental Association

If the legislation had gone into effect, it would have ensured a cardholder the full Delta Dental discount on all dental work performed by a participating dentist even if it was not covered by the plan or not covered because the patient had exhausted their annual maximum, according to the RIDA.

The Delta Dental discount amounts to more than 30%, according to the RIDA.

"The impact of this policy on the dental practice could even worsen when one considers that Delta and Blue [Cross] both offer plans for under $400 that include minimal benefits such as examination, a few x-rays, and a cleaning or two," the RIDA stated in an alert sent out to its constituents in late June. "All dentistry for the $400 card holder will be at the Delta discount."

"We thought it was unfair trying to dictate fees on uncovered procedures," RIDA President Francis Connor Jr., D.D.S., told DrBicuspid.com. "It is bordering on unconstitutional."

In Rhode Island, almost 90% of the dentists participate in the Delta Dental network -- one of highest levels in the U.S., Dr. Connor said. Delta Dental has tremendous influence on the economics of dental practice in the state, he added.

According to Dr. Connor, this policy could have affected the recruitment of young dentists in Rhode Island. "Right now, young people have the option of going to neighboring Massachusetts and Connecticut, where fees are almost 30% higher," he said. "Compensation levels are already low in Rhode Island. This policy would have further discouraged young dentists from practicing in the state."

Given that Rhode Island has an aging dental population, this lowers the prospect of new dentists coming in and buying the practice of a retiring dentist, he added.

"The Senate and House unanimously decided to pass this legislation," Dr. Connor said. "They were behind it 100%."

Other concerns voiced by the RIDA were that this new policy could disrupt long standing patient/dentist relationships. In addition, the policy would be unfair to private-pay patients since the cost incurred by absorbing these additional discounts would be shared by all patients. It could also force a dental practice to eliminate a position.

Delta Dental, however, defends its policy by pointing out that patients would be the ones to benefit most from carriers holding dentists to maximum allowable charges for noncovered services.

"Subscribers are more likely to initiate and follow through with treatment plans they otherwise might have neglected or postponed, which increases the volume of dentists' patients seeking these services," said Tom Dolatowski, vice president of business development at Delta Dental Plans Association, in an interview with DrBicuspid.com.

According to Dolatowski, the following are some of the key reasons Delta Dental decided to implement this policy:

  • To improve consistency of administration within national network-based products, which could benefit dentists, patients, and group customers alike. The majority of Delta Dental subscribers were already covered under some form of this policy before the company decided to implement it nationally.

  • To provide an additional value-added benefit for group customers and their employees. As this policy will only apply to procedures for which Delta Dental has credible data to develop reasonable fees, the impact to participating dentists will be minimal.

  • To meet the marketplace challenges presented by the fact that most of their national competitors have already implemented this policy.

"This new legislation will hurt patients the most," Dolatowski said. When carriers are able to hold dentists to a maximum allowable charge for noncovered services, patients can get procedures that they might not otherwise seek, he added.

"At Delta Dental, we believe that everyone deserves good oral health, and therefore seek to minimize financial barriers to oral healthcare services," Dolatowski concluded.

Copyright © 2009 DrBicuspid.com

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