G ove r n men t Re lat ions
PDA Moves HB 564 out of the House
Insurance Committee Need contact info for your legislator? Check out the General
Assembly’s website at http://www.legis.state.pa.us.
CONTACT YOUR REPRESENTATIVE AND REQUEST SUPPORT
FOR HB 564 AS AMENDED BY THE HOUSE INSURANCE
COMMITTEE • PDA supports legislation to clarify Act 68 of 1999 so all
patients can be treated by their dentist of choice.
In June, PDA leaders, lobbyist and staff met with Rep. Tina
Pickett, chair of the House Insurance Committee, to request that
she schedule HB 564 for a committee vote. Rep. Picket’s senior
staff proposed stripping HB 564 to include language from
Act 68 of 1999, which requires insurers to promptly pay clean
claims submitted by participating and non-participating
providers. PDA’s legal counsel opined that the practical
application of Act 68 still does not ensure direct payment to
non-participating providers, just that the insurer pay the clean
claim promptly (payment can still go directly to the subscriber).
Current interpretation of the existing law did not guarantee
direct payment to non-participating providers, which means
that it is still necessary for PDA to lobby for legislation.
After consultation with legal counsel and PDA’s lobbyists, the
Board of Trustees and Government Relations Committee agreed
that the best course of action was to strip HB 564 to include
language that amends Act 68 to make clear that payment
should be sent directly to non-participating providers, and that
PDA should lobby to have the House Insurance Committee vote
on this amended version before the budget passes at the end
of June. This was the only way to move the bill out of committee
before the summer recess.
PDA retains the ability to amend the legislation in the future if
necessary, but it was essential to first vote the bill out of
committee. The House Insurance Committee voted HB 564 out
of committee on June 27. The legislature adjourned a few days
later after passing the state budget and returned to session in
late September.
Now is the time to schedule a meeting or make a phone
call to your representative to request his/her support for
HB 564, as amended by the House Insurance Committee
in June.
We are now calling this “direct pay,” not “assignment of benefits,”
legislation. Please use the revised talking points below to
educate your representative about why the bill was amended
(to clarify an existing law) and how it is still a consumer friendly
bill that will improve access to dental care.
HB 564 TALKING POINTS
• PDA thanks Rep. Stan Saylor for introducing legislation to
provide dental patients with more control over their oral
health care. HB 564, as amended by the House Insurance
Committee, simply clarifies Act 68 of 1999, which was
intended to require insurers to directly pay clean claims to
providers within 45 days, regardless of their participation with
any of the insurers’ plans.
• HB 564 will drive down health care costs by simplifying the
payment and reimbursement process for patients and health
care providers.
Reasons to Support HB 564
HB 564, as amended by the House Insurance committee in
June, simply provides clarification to an existing law. The
original intent of Act 68 of 1999 was for insurers to pay clean
claims within 45 days to participating and non-participating
providers. The insurers have found a loophole with the current
interpretation of Act 68 of 1999. HB 564 as amended would
close the loophole so that all insurers are complying with the
law as intended.
The House Insurance Committee executive director pointed out
that Act 68 of 1999 already exists to help non-participating
providers receive payment directly and suggested that PDA
support amended language to HB 564 that clarifies the issue of
direct payment. PDA’s legal counsel agrees with this
interpretation.
Despite claims made by insurance lobbyists, Act 68 has been in
existence for 20 years and there has been no decline in network
participation. Those insurance companies that already assign
benefits to non-participating providers have experienced no
decline in network participation.
Directly paying patients’ provider of choice will eliminate
financial and administrative burdens for both patients and
dentists, and ensure timely care. Passage of HB 564 as amended
will give all patients the fundamental freedom to be treated by
the dentist of their choice.
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