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Groups for dentists and groups for dental plans are clashing over the future of dental services provider network leasing rules.
The outcome could affect whether dental plans must persuade the dentists in their provide networks to opt in when the plans are leasing use of the networks to outside organizations, such as dental insurers, employers' self-insured plans or providers of alternatives to traditional dental insurance, such as dental discount programs.
Members of the National Council of Insurance Legislators — a group for state lawmakers with an interest in insurance — are talking about the topic this week in Chicago, at NCOIL's summer meeting.
NCOIL is now working on reviewing and readopting the Transparency in Dental Benefits Contracting Model Act bill it adopted in 2020.
A network leasing provision in the 2020 model lets dentists opt out of network leasing arrangements. A readoption draft now under review could replace the network leasing opt-out provision with an opt-in provision.
Shifting to an opt-in approach would be a mistake, according to a comment letter sent to NCOIL by representatives from the National Association of Dental Plans, the Delta Dental Plans Association and two other insurer groups.
"When providers are not automatically included in leased networks, patients may unknowingly receive care from out-of-network providers, resulting in unexpected out-of-pocket expenses," the insurer groups wrote in the letter.
Shifting to an opt-in provision could also slow plan efforts to pay dentists, the reps told NCOIL.
The letter was signed by Bianca Balale, the NADP's director of government relations; Jill Rickard, regional vice president for state relations at the American Council of Life Insurers; Miranda Motter, senior vice president for state affairs and policy at America's Health Insurance Plans; and Araceli Gutierrez, Delta Dental's director of government affairs.
NCOIL: NCOIL has no ability to set state laws, but state lawmakers can use the model laws NCOIL develops or consider NCOIL models when drafting bills.
As of June, 15 states had adopted NCOIL's opt-out approach to dental work leasing,
Related: Bipartisan dental and vision plan network bill returns in House
Only about 3% of dentists now opt out of network leasing arrangements, according to the insurer groups.
Network leasing: Managed care plans now rely heavily on provider networks, or groups of providers who have signed a contract with the network manager and agreed to the manager's terms, to provide benefits.
Supporters argue that use of well-run provider networks helps the network managers enforce care quality standards, arrange for discounts, and reduce or eliminate the odds that the providers will send the patients unexpected bills.
In some cases, providers have backed policy efforts that would increase their ability to get into plans' networks.
Some providers have also backed efforts to increase their level of control over network managers' arrangements to make the providers in the networks available to "third parties," or outside parties.
Providers have argued that patients coming in through the third parties may be less likely to pay their bills or differ from the patients in the original stream of patients in other ways.
The policy backdrop: The discussion at NCOIL is occurring as medical doctors, mental health providers, vision care providers and pharmacists are also organizing efforts to shape provider network rules at the state level and in Washington.
Key members in the U.S. House seem to be keenly interested in provider network policy proposals.
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