SB1138 - Dental Insurers: website; overpayments; predeterminations (Sen. Sylvia Allen)
Dentists report that one of the most challenging aspects of running a dental practice are complications and administrative challenges associated with third-party payors/dental benefits. Patients and dentists require a clear understanding of a patient's benefits with minimal confusion and an understanding of the level of reimbursement can become a factor for a patient in choosing between multiple treatment options. Patients also deserve to have accurate information about their financial obligations before proceeding with treatment.
A recent poll of 195 dental practices in Arizona found that more than 60% of respondents spend 10 or more hours weekly verifying dental benefits. The labor cost alone for these practices ranges from $15,600 to $62,400 annually, as administrative staff spend hours on the telephone on a daily basis attempting to determine exactly what the plan covers. Misleading information, especially information that leads to additional out of pocket costs leaves patients both surprised and angry. Patients often express that anger by refusing to pay the dentist.
Both the dentist and the patient have the same goal–to maximize the ability to achieve and maintain optimal oral health. However, the ability to achieve this goal is compromised when insurers put up administrative and financial barriers that lead to additional costs and inefficiency that hinder or complicate the dentist- to-patient relationship.
The Arizona Dental Association supports Senate Bill 1138 which will:
- Provide transparency by requiring state-regulated dental insurers to create patient benefit web portals for use by patients and both in-network and out-of-network dentists.
- Prohibit state-regulated dental insurers from mandating payment methods to dentists.
- Prohibit state-regulated dental insurers from denying dental claims approved in prior authorization.
- Prohibit state-regulated dental insurers from withholding payment(s) to a dentist because of an alleged “overpayment” to another dentist.
AzDA POSITION STATEMENTS
Provider Web Portals
- Dental patients and dentists need timely and accurate information about benefits.
- It is onerous and inefficient for dental offices to verify patients’ enrollment, eligibility and scope of benefits over the telephone.
- Requiring dental insurers to have patient benefit web portals for use by patients and both in- network and out-of-network dentists reduces inefficiencies in both eligibility verification and claims processing for dentists and patients across Arizona.
- Easily accessible, comprehensive, and standardized patient benefit web portals will improve dentist-to-patient communication and increase the likelihood of more informed patient decisions.
- Dentists are often required to seek and receive prior authorization from dental insurers for patient procedures before the procedures may be performed. This process helps to manage the patient’s expectations and the financial exposure associated with their dental treatment plan.
- Insurers may very often deny payment(s) for these procedures despite having granted prior authorization.
- It is both unfair and unreasonable for insurers to authorize a dentist to perform procedures and then subsequently deny payment for the procedure.
- Other states, including Louisiana, California and Texas, have already recognized this unfair practice and passed legislation requiring payment from insurers for prior authorized dental treatment.
- Some insurers will deduct payment to a patient’s treating dentist due to an alleged “overpayment” made to an entirely different dentist treating a beneficiary under the patient’s insurance plan.
- This is unfair and punitive to the treating dentist, leaving the dentist financially exposed for an error that is never under their control.
- State-regulated insurers should be prohibited from collecting “overpayments” from a dentist who did not treat the patient for which the “overpayment” occurred.
Support SB1170 (Carter); HB2727 (Osborne) - AHCCCS dental coverage for expectant mothers
Votes for these bills will demonstrate legislative support to fund this benefit that will result in healthy mothers and healthy babies and will save the State the significant costs of pregnancy complications and pre-term birth. Ultimately, funding for the coverage needs to be put in to the FY2021 State Budget. Dentists should tell their Senators and Representatives that this coverage has had wide bi-partisan support for the last three sessions, and request that they make this part of their “budget ask” during budget negotiations.
Support HB 2668 - The Health Care Investment Act (Cobb)
Since 2010, fees paid to AHCCCS dentists have dropped by 12.5%. Passage of HB2668 will provide a huge boost to the Arizona economy by providing $1.1 billion in combined State and Federal funding to cover support for our hospitals and our health care work force and provides $350 million to restore AHCCCS/Medicaid rates to physicians AND DENTISTS to pre-recession levels.
HB 2668 has been introduced by our own Dentist/Representative Regina Cobb, who also happens to be the Chair of the House Appropriations Committee.