Insurers Shouldn’t Get to Set Fees for Treatments They Don’t Cover

This spring, a bipartisan group of lawmakers introduced bills in both the House and Senate that would ban what’s called noncovered services provisions in agreements between dentists and insurance carriers.

Typically, when a dentist contracts with an insurer, the insurance company sets a fee schedule for any procedures covered under their plan. A dentist who charges $2,000 to do a crown fee-for-service might only be allowed to bill a Delta Dental patient $1,400 for that same crown.

Dentists agree to this because they’ll typically end up doing more crowns as a result of working with an insurance plan, so they come out ahead financially even though each procedure generates less.

However, a noncovered services provision allows an insurance company to also set fees for procedures that they… don’t cover. In other words, Acme Dental Insurance might tell a practice that normally charges $4,000 for a single tooth implant that any patients who have Acme will only pay $3,000 for that same implant — even though Acme itself won’t pay a dime towards those patients’ costs.

We think this is a raw deal for dentists. Small wonder that 45 states already outlaw noncovered services provisions, but in the five that don’t — plus the many plans regulated at the federal level — dentists who want to work with insurance providers are forced to accept that provider’s pricing decisions for non-insured treatments.

We (along with the ADA, we might add) believe that it’s time for this to change and we’re hoping the bills become law. 

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