Government Relations
We know that third-party payer issues are of utmost concern to members . Because of that , PDA ’ s Government Relations Committee and the Board of Trustees have directed that our lobbying and advocacy resources be used almost exclusively for dental insurance reform ( DIR ) initiatives for the 2023-2024 legislative session .
Ove the summer months , PDA ’ s volunteer leaders , lobbyists and staff laid the groundwork for advancing PDA ’ s DIR bills through the legislative process . We ’ re focusing on three DIR initiatives that are designed to help level the playing field with insurers to improve the practice environment for dentists and enhance their ability to care for patients . PDA will also monitor and respond to any other third-party payer issue that may arise during the session .
Through our involvement with the ADA ’ s State Public Affairs Program , we are contracted with an additional lobbyist to represent PDA at the Capitol and legislative fundraisers , and to be another set of eyes and ears on the ground to pursue our legislative goals and counter opponents of our DIR legislation .
DIR Legislation
Prohibiting insurers from requiring virtual credit card payments only
Rep . Greg Scott introduced 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 . We ’ re optimistic that the bill will be introduced and “ moving ” when the session resumes this fall .
PDA ’ s “ virtual credit card ” legislation , HB 1664 , will prohibit dental insurers from adopting a policy that they pay dental claims using a credit or debit card equivalent only , and that they provide proper notice and disclosure of payment option to dentists . The legislation :
• Will not prohibit insurers from using virtual credit card payments altogether . It simply states that virtual credit cards cannot be the only option .
• Will require that insurers provide notice to dentists of all payment options and any fees imposed by the insurer or its contracted vendor whenever initiating or changing payment using electronic funds transfer .
• Will give dentists the ability to opt into the payment option that works best for their dental office or facility .
Some dental insurers have tried to enforce a policy that dentists must accept claims payment using a credit or debit card equivalent , rather than given an option to pay with a paper check or direct deposit . The virtual credit card 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 5 %, or pass the additional cost on to patients . Adding insult to injury , insurers sometimes get a percentage of the transaction fee .
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 .
Rep . Kyle Williams introduced 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 . HB 1415 was assigned to the House Insurance Committee .
SEPTEMBER / OCTOBER 2023 | PENNSYLVANIA DENTAL JOURNAL 9