Government Relations
More than 100 dentists , spouses and dental students traveled to Harrisburg on June 14 to advocate for issues of concern to the profession and patients . Access to care issues and insurance reforms were at the forefront of PDA ’ s lobbying efforts and we remain hopeful that the legislature will pass a couple of these initiatives before the end of the year .
Pennsylvanians face the stark reality , though , of not having enough money in the state budget to continue some existing programs . This may include cuts to the adult Medical Assistance program as the Department of Public Welfare must slash $ 400 million from its budget . See the next page for a further update on the MA program .
PDA Testifies Before House Insurance Committee
On May 11 , PDA testified at a public hearing before members of the House Insurance Committee in support of HB 532 , legislation requiring insurers to cover general anesthesia when needed to provide dental treatment to at-risk patients . Eligible patients include children seven years of age and younger and special needs patients of any age . Coverage would apply when general anesthesia is administered in a health care facility , including dental offices .
Testifying on our behalf were Dr . Dennis Charlton , PDA president , and Dr . Andrew Mramor , vice chair of PDA ’ s Government Relations Committee . They were accompanied by Dr . James Boyle , a PDA member also representing the Pennsylvania Society of Oral and Maxillofacial Surgeons ( PSOMS ). They each addressed the need for private insurers to cover general anesthesia costs , the number of states that already provide such coverage and the potential costs to patients and taxpayers when dental problems are neglected .
Testifying in opposition to HB 532 were the Insurance Federation of Pennsylvania and Independence Blue Cross . They questioned the safety of general anesthesia in the dental office , cited the difficulty of establishing a network for non-participating dentists administering general anesthesia and warned of increased costs of insurance premiums . After the hearing , PDA followed up with committee members to address the insurers ’ inaccuracies and incorrect statements .
The House Insurance Committee failed to vote on HB 532 before the summer recess but will most likely schedule a vote in the fall .
Rep . Murt Introduces Insurance Bills PDA is striving to make Pennsylvania a more attractive state in which to practice dentistry . As small business owners , dentists often look at a state ’ s economic forecast , and whether its business and insurance practices are friendly to the dental profession . We have identified several policy initiatives that would enhance Pennsylvania ’ s reputation among dentists searching for the right place to practice dentistry . Rep . Thomas Murt ( R-Montgomery ) introduced two insurance-reform bills on PDA ’ s behalf :
• HB 1536 would require insurers to assign benefits to non-participating providers . PDA believes assigning benefits is an issue of protecting patients ’ ability to choose their dentist , regardless of whether he or she participates in insurers ’ plans . Patients should have the right to choose their dentist and their health insurance plans should be required to respect that choice by paying the dentist directly . This legislation does not change the amount insurers would pay for the services . It only changes to whom they write the check .
We also believe that without assignment-of-benefits , divorced parents with children are less protected if one parent pays for the dentist ’ s bill covered by the other parent ’ s insurance , and the second parent does not send the reimbursement check to the dentist .
We are meeting with members of the House Insurance Committee to educate them about the issue and lobbying the committee chair to place this bill on the agenda for consideration once it is introduced .
• HB 1537 would prohibit insurers from capping non-covered dental services . Dentists who participate with insurance companies are being asked to sign contracts that will prohibit them from charging patients their usual and customary fees for non-covered services . The impact of this contractual change for dental practices could be significant if the reimbursement for non-covered services is too low for dentists to cover their overhead expenses , pay their employees , etc . Dentists may have to choose between economic hardship and disrupting relationships with patients if they are forced to drop out of network .
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 .
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July / August 2011 • Pennsylvania Dental Journal
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