Congratulations!

Because of your hard work, making calls, and sending emails and faxes, SB 2051, the ODA’s bill prohibiting insurance companies from capping fees on non-covered dental services, was signed by Governor Henry! The law will go into effect November 1, 2010. Thank you so much for all your hard work and commitment!

Read below for background information about SB 2051…
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SB 2051
Preventing Oklahoma Insurance Companies from Capping Non-Covered Services
Here’s the facts…

Did you know?
• A national trend has developed where insurers are setting caps on dentists’ fees for services not covered by the insurance plan. This policy sets a cap on the amount that a participating dentist can bill the patient for services not covered by the plan, thus setting a maximum allowable fee on non-covered services.
• This is a business decision on the carriers’ part with full awareness of the implications for relations with their provider networks. In down economic times, this is a calculated risk they may be willing to take to reduce costs and shift risk to provider networks to remain competitive in the marketplace.
• Most dental insurance carriers in Oklahoma have adopted this practice and have been imposing these caps on dentists for more than a year.

What has been done?
• The Rhode Island Dental Association was successful in their effort to pass legislation to prevent dental insurance carriers from capping fees on non-covered services. The Governor recently signed into law House Bill 5454. Senate Bill 0390 was also signed—replica bills introduced in the House and Senate were both enacted. With this victory, a number of other state dental associations have expressed interest in following Rhode Island’s lead on this issue. It should be noted that the growing interest indicates this to be a current or potential issue in all states.

What are a few key advocacy points to consider about SB 2051?
• Importance of Oral Health
In 2000, the US Surgeon General aptly stated that you are not healthy without good oral health; an important key to overall health is through oral health. The fact that millions of productive hours are lost (for students and workers) each year due to oral health conditions helps prove the importance of oral health care. Financing oral health is an important part of insuring access to care and dentists have a record of donating billions of dollars in free or discounted care each year. Insurers and dental benefit plans are an important part of the preventive and treatment process.
• Disruption to Patient Care
At the outset, the reduced fees help the insurer attract customers and, therefore improves the insurer’s bottom line. Doctors front the costs of this marketing approach and have a tough decision to make when faced with a contract amendment that caps the non-covered fees. Patient disruption can ensue. Small dental practices who object to being the primary payers for the insurance companies’ marketing approach have two choices: 1) accept the contract amendment or 2) end their contractual relationship. It is a private business choice for dentists. Patients could, then, lose the benefit provided by their insurance carrier and either have to pay more to stay with their dental home, or seek care from another practitioner. Disruption to treatment should be a real concern.
• Market Forces and Effects
Should the private practitioners who have annually donated nearly a quarter of a billion dollars in free and discounted care additionally be asked to back the insurance companies’ marketing plan that impacts the insurer positively, but at no cost to the insurance companies? Patients will see a reduced cost initially, however long term affects are not known. Study needs to occur on the total impact this policy will have on the oral health care system. It is unwise to allow such a drastic policy change, especially in this very tenuous economy and especially in the even more delicate health care financing market.
• Cost Shifting
Reducing the amount allowed to be charged is an erroneous method to reducing costs. Costs are simply passed on; they do not evaporate. Reducing the cost of a product or service most certainly has an economic impact that simply must be considered carefully before implementing-especially in these very delicate times. Our lawmakers should be asking: Has the insurance industry done such research and is it available for public review? Simply reducing the MAC is not a logical and proper method to reduce ACTUAL costs. This could affect jobs and economic growth.
• Basic Fairness
Is it appropriate for a 3rd party to minimize financial barriers when the very same 3rd party has no participation in sharing in the real cost? The insurance companies’ approach is something of a paper tiger in that they proudly offer aid to patients seeking care but hide behind the sole practitioner when it comes to determining how to finance their very own policy. They accept no financial participation—but certainly enjoy the benefits of the marketing ploy at no expense to them. Where is their true commitment to patients, their fiscal support?
• Good Will
Extending a note of appreciation for the insurer’s commitment to patients’ access to care concerns is appropriate. But, it is also appropriate in this situation to question their sincerity as the policy in question is a disingenuous approach to financing access to care. Where does their dedication to the patient (as they would have you believe) shine through?—the simple truth is, it does not. This is a marketing tool that is financed solely upon the backs of the private practitioner / small business owner. The employer providing jobs in the community is forced to put their private fees on permanent “sale” and find some way to make up for the loss in revenue. Have these insurance companies determined the impact this will have on practices? Will jobs be lost, will equipment not be purchased for patient safety? What are the actual costs? Until these questions are answered, it is very unwise to continue to support this policy. Until the insurance companies show a commensurate commitment to the patient as they say is their focus, this policy should not be allowed.


- The ODA would like to thank the office of Political Affairs of the American Dental Association for their assistance with this information.