While a growing number of U.S. states have already adopted legislation making it illegal for dental insurance providers to set fee caps on dental procedures not included in patients' policies, a new bill introduced by Rep. Robert Andrews (D-NJ) would mandate this at the national level.
HR 1809, the Dental Coverage Value and Transparency Act, would prohibit health plans offering dental benefits from dictating fees for procedures that the plans do not cover. HR 1809 also requires them to provide uniform coordination of benefits, along with other provisions to provide greater uniformity and transparency for dental coverage.
Under the bill, dental plans would be required to do the following:
- Permit a participant or beneficiary to designate payment of dental benefits to a provider who is not participating in the network.
- Provide the same dollar amount of coverage for a given procedure regardless of whether the provider of the procedure is participating in the network.
- Not permit the application of the plan's or network's fee schedule to services for which no benefits or reimbursement are provided.
The bill, which was introduced on May 10 and referred to the House Committee on Education and the Workforce, is cosponsored by Rep. Paul Gosar (R-AZ) and Don Young (R-AK). Gosar is a former dentist who sold his practice to run for office in the most recent congressional election.
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