On March 26, 2015, Rep. Paul Gosar, DDS (R-AZ) introduced H.R. 1677, the Dental Insurance Fairness Act of 2015, legislation that helps consumers receive the full value of their dental coverage by amending the Employee Retirement Income Security Act (ERISA) to allow for uniform coordination of benefits and the ability for patients to assign the payment of benefits directly to their dentists. Rep. Gosar first introduced this important legislation in 2012.
More specifically, under H.R. 1677:
All self-funded health plans that offer dental benefits would provide uniform coordination of benefits. When a consumer is covered by more than one plan, the secondary payer should be responsible for paying the remainder of the claim (up to, but not exceeding, 100 percent of the amount of the claim). To do otherwise provides the insurance industry with an unfair gain at the expense of beneficiaries.
All self-funded health plans that offer dental benefits would permit assignment of benefits. The bill would permit consumers to designate a dental plan’s payment to providers who do not participate in the network (called “assignment of benefits”), so that the patient’s family does not have to pay for covered services out-of-pocket and wait to be reimbursed by the plan.
Impact on General Dentistry: The AGD was pleased to see Rep. Gosar renew his efforts to end unfair dental insurance practices that prohibit consumers from receiving the full value of their dental coverage. AGD members are encouraged to participate in the AGD’s action alert on this issue to urge their legislators to cosponsor this legislation and ask that it be brought to a vote. The AGD has also signed onto an Organized Dentistry Coalition (ODC) letter in support of H.R. 1677.