Government Relations
PDA ’ s volunteer leaders , lobbyists , and staff have begun to lay the groundwork for advancing our Dental Insurance Reform ( DIR ) bills through the legislative process . We ’ re focusing on three DIR initiatives that are designed to help level the playing field with insurers and improve the practice environment for dentists and enhance their ability to care for patients .
DIR legislation
Prohibiting insurers from requiring virtual credit card payments only
Some dental insurers have adopted a policy that dentists must accept claims payment using a credit or debit card equivalent , rather than a paper check or direct deposit . The transaction usually involves the insurer providing a series of numbers that the dentist enters on a website or credit card terminal to complete the claims payment . Dental practices must absorb the transaction fees , sometimes as high as five percent , or pass the additional cost on to patients . Adding insult to injury , insurers sometimes get a percentage of the transaction fee .
PDA is introducing legislation that requires insurers to provide other payment options besides virtual credit cards and gives dentists the ability to opt into the payment option that works best for their dental office or facility . PDA has identified a sponsor in the House of Representatives and is in the process of identifying a sponsor in the Senate .
Medical Loss Ratio Transparency
Some states have laws that require dental insurers to report annually their medical loss ratio ( MLR ) for dentistry . Filing an MLR report is already a requirement under the Affordable Care Act for insurers offering medical health plans . A law establishing a reporting requirement on an MLR for dentistry — the percentage of revenue from premiums spent on patient care — would enhance transparency for patients seeking oral health care and make dental insurers more accountable . It is important for the Commonwealth to have a mechanism to obtain this information from dental insurers and make it accessible to the public .
PDA is introducing a bill in the House that requires dental insurers to report annually their medical loss ratio ( MLR ) for dentistry to the Pennsylvania Insurance Department . Establishing a reporting requirement on an MLR for dentistry — the percentage of revenue from premiums spent on patient care — would enhance transparency for dentists , patients , and policymakers .
Streamline Credentialing
Dentists , especially new dentists , and those completing dental residency programs , routinely face situations in which the insurer does not credential them within a reasonable time period . The result is that either the dentist is unable to work , thereby jeopardizing potential employment opportunities , or the dentist and / or facility is not reimbursed during this time . Even more significantly , patients are negatively impacted when the insurer fails to credential fully qualified and licensed dentists in a timely manner .
The credentialing process is also redundant , with dentists having to use the same information to credential ( and recredential ) with multiple insurers . Dentists who practice in multiple locations must also have credentials for each location .
PDA is working with a coalition of other health care practitioners to introduce legislation that requires use of a universal credentialing application and establishes a deadline in which insurers must complete the credentialing process . This legislation will be introduced in both the House of Representatives and the Senate .
MAY / JUNE 2023 | PENNSYLVANIA DENTAL JOURNAL 7