THE ADA/UDA IS FIGHTING FOR YOU

Dear Dr. Butler,

Thank you for your inquiry into my article in the January/February 2023 edition of the UDA Action, “We Need You!” I appreciate you caring enough to reach out on this important topic, and welcome the opportunity to respond. Undoubtedly, these same questions are on the minds of many dentists. You justifiably ask why? From your letter, let’s take your questions one-by-one:

1. What is the ADA/UDA doing to fight for what keeps us in business?

A. In 2017, the UDA was a major player in the passage of legislation that prohibited Utah state regulated dental insurance carriers from setting fees for dental procedures not covered under their plan.

B. In 2020, the UDA advocated for language in HB 37 that allowed dentists to opt out of virtual credit card payment methods utilized by some insurance companies. As with any credit card transaction, these virtual credit cards tacked on an additional discount to the fee charged by the dentist. With UDA support, this bill passed and was signed into law. This provision only applies to Utah regulated dental insurance carriers.

C. In 2020 and 2021, the ADA played a pivotal role in legislation that overturned parts of the longstanding McCarran-Ferguson Act, specifically to remove the federal antitrust exemption for health and dental insurance companies. In other words, largely because of ADA efforts, no longer do insurance companies enjoy the unfair advantage of not having interstate competition. This alone is a huge victory for dentists and all consumers of healthcare.

D. In 2022, the ADA successfully lobbied congress to exempt dentists from some of the federally mandated training required for DEA licensure renewal. Without the ADA’s efforts to stay on top of this type of legislation, the MATE (Medication Access and Training Expansion) Act would have sailed through congress requiring you and I to complete 3 additional, irrelevant hours of training specific to prescribing buprenorphine, a medication completely outside the practice of dentistry.

E. In 2022, the ADA helped defeat a congressional proposal to add a dental benefit to the Medicare Part B program. The ADA maintains that if dentistry is ever forced to be a part of Medicare, that it be accomplished through a separate program, and provide for comprehensive dental care. More to come on this one.

F. The ADA advocated for the Ensuring Lasting Smiles Act (ELSA), which would require that all private group and individual health plans cover medically necessary services resulting from a congenital anomaly or birth defect. The services covered under ELSA would include inpatient and outpatient care and reconstructive services and procedures, as well as adjunctive dental, orthodontic, or prosthodontic support. This bill is still working its way through the legislative process, but in April of 2022, ELSA passed the House of Representatives with 310 votes.

G. In 2022, the ADA worked with Massachusetts Dental Society to secure a win on “Question 2,” which establishes an 83% medical loss ratio for dental plans along with a rebate if dental plans do not meet that stipulation. The ADA staff was fully engaged in the campaign, and closely supervised the ADA’s $5.5 million investment in support of the resolution. The UDA is committed to following Massachusetts with similar legislation. But, efforts like this come with a cost, another reason why “We Need You” and every other dentist in this state. Twenty-two state dental societies received State Public Affairs (SPA) funding to engage in third party payer issues on the state level. To date, there are 11 new laws in five states enacted in 2022 that improve the position of dentists and/or patients with regard to dental insurance.

H. During the 2023 legislative session that just ended in Utah, SB 237 was introduced by Senator Michael McKell. This bill was heavily supported by the Utah Dental Hygienists’ Association. In its original language, it would have basically given hygienists the ability to practice independently in Utah, without the supervision of a licensed dentist. However, due to the efforts of the UDA, the language of this bill was changed significantly. In its final version, this bill actually improved DOPL’s ability to regulate and oversee any departure from the practice of dental hygiene not under the direct supervision of a licensed dentist.

2. Is the ADA helping dentists in litigation efforts against dental insurance companies?

From a November 5th, 2021 article in the ADA News, ADA’s class action lawsuit against Delta Dental ongoing: “The ADA’s lawsuit alleges that Delta violated federal antitrust laws by allocating territories of operation and dividing the national market in order to restrict competition and reduce reimbursement amounts.

The complaint goes on to allege that Delta’s allegedly anticompetitive acts hurt both dentists and their patients by limiting the choices of dental care available to patients and making it more difficult for dentists to deliver the care that patients need and want.

Numerous individual dentists also filed class action complaints against Delta, and the allegations in the various complaints have since been combined into a single consolidated complaint.”

Yes, the ADA is in the trenches and working side-by-side with the dentists that are going up against this, and other insurance behemoths! This class action lawsuit is ongoing, but unfortunately due to the nature of class action lawsuits, will probably not go to trial until 2024 or later.

3. Is the ADA working to stop insurance companies from bundling services?

A. In 2021, HB 359 was passed and later signed into Utah law. Because of the UDA’s efforts, language was included which prevents an insurance carrier from offering a plan that, uses bundling in a manner where a procedure code is labeled as non-billable to the patient, unless under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure. While this does not completely preclude the unethical practice of bundling by insurance companies, it is a step in the right direction, and represents many hours of effort on the part of the UDA working alongside My Practice My Business.

B. The practice of downcoding was also addressed in that same piece of legislation. Consequently, insurance carriers are now unable to downcode in a manner that prevents a dental provider from collecting the fee from the carrier or the patient for the actual service provided. Again, this law will not prevent every attempt by an insurance carrier to 1) either reduce the patient’s benefit or 2) attempt to make the dentist look bad. Some of that comes from the minutia written into each specific insurance contract. Again, dentist beware! Each dentist needs to be wise in how they deal with insurance and which insurance companies they agree to contract with in their practice.

4. Is the ADA working to help dentists provide the best care without insurance companies undermining our efforts? Is the ADA going to fight for me? And, if not the ADA,will the UDA?

A. Please allow me to respond to these questions together, as they are all closely related: Both the ADA and the UDA are fighting for you, and every other dentist in this state. Even our colleagues who are not members are benefiting from the efforts of organized dentistry. While the ADA/UDA can legislatively act to improve insurance company transparency and limit their ability to take unfair advantage of us and our patients, the ADA/UDA cannot violate antitrust laws, nor can it supersede contract law when it acts to represent us. There is an insurance contract analysis service (another benefit) that is available to UDA/ADA members; but that service does not preclude a dentist from making a poor business decision when they sign up with some insurance carriers. Some contracts will severely tie the hands of the dentist and significantly limit benefits for the patient. At the end of the day, that contract is the responsibility of the individual dentist. And, we should “just say no” to some contracts.

B. The ADA’s Department of State Government Affairs (DSGA) provides technical assistance and resources for state dental societies. In 2022, at least 16 states sought DSGA’s feedback and advice on a number of dental insurance reform bills. Almost half of these bills became law. Some of the issues in the bills were non-covered services, prior authorization, medical loss ratio/rebates, and virtual credit cards.

I have just touched upon the issues that relate more to dental insurance and the business of dentistry. There are more examples, many more. But, in the interest of brevity, I will conclude. Yes Dr. Butler, organized dentistry, the ADA and the UDA, are doing much to not only keep us in business, but to help us thrive in business. We need you, and we need your colleagues. Dentists like you, who care enough to take the time to reach out, ask questions, and keep us accountable are just who we need. I hope this helps to answer your thoughtful questions. Thank you again for asking them!

Dr Mark R. Taylor UDA President