04/03/2019

Bill sponsored by CDA protects dentists during network leasing


Moving through the state Legislature is a CDA-sponsored bill that, if signed into law, will bring more transparency to network leasing by dental benefit plans — a process that often leaves dentists and their patients in the dark.

The growing trend of network leasing is causing confusion and difficulties for California dentists and their patients. Currently, dentists are not always aware that their name or contract with a health care benefit plan is going to be sold as part of a leased network — that is, sold or issued by a contracted plan to another plan or third-party contractor that covers dental services. Often this is because the notice that the provider network will be sold or leased is buried in the plan contract or plan letter. But even some dentists who are aware that a plan is leasing them as part of a provider network may not know which plans they’ve been sold to or be able to access them.

Assemblymember Jim Wood, DDS, says this presents numerous problems for dentists and their patients. AB 954, his new legislation sponsored by CDA, aims to fix these problems.

“The plans that lease or purchase networks don’t have any responsibility to be transparent about which fee schedules are in effect for their patients, and this legislation will fix that,” Dr. Wood said. “Dentists are sensitive to the price concerns their patients have and they need this transparency to be able to clearly discuss treatment options and out-of-pocket costs with them.”

Patients are harmed when dentists can’t easily locate the terms of a new contract in order to communicate service terms during treatment planning. Limitations on services, waiting periods, how treatments are categorized — all can have a major financial impact on the patient. Charging the wrong co-pay also puts patients on the hook for costs. And because of the lack of transparency, dentists are blindsided by unexpectedly low in-network rates.

The lack of communication between the selling and purchasing dental plans is another problem. A dental plan selling its network currently has no responsibility to make sure that a dentist who opts out or cancels their contract is removed from a leased network. Because of this, dentists and patients are “caught in between with the dental plans pointing fingers at each other,” Wood says. He adds that the administrative time spent trying to track down information on plan benefit details can keep office staff from helping patients and performing other tasks most effectively.

AB 954 will do a couple of things to remedy the current transparency problems. First and foremost, as of January 2020, it prohibits a health care plan contract from granting a third party access to a provider network contract unless certain criteria are met. This includes clearly identifying the provision of third-party access, naming the third parties who will have access to a provider network contract and giving dentists the ability to opt out.

Dental plans would additionally be required to maintain a list of all third parties who have access to the provider network and update this list every 90 days. The third parties must identify discount sources on their remittances and explanation of benefits, and the selling dental plan must notify the third party of any contract termination within 30 days.

AB 954 provides protection for dentists by ending a third party’s right to the network discounted rate once a provider’s contract has been terminated so that, as the bill language states, they “are not bound by or required to perform dental treatment or services under a provider network contract granted to a third party” that violates the previously stated provisions.

CDA is sponsoring AB 954 and will update members on the bill’s status as it moves through the Legislature.




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