Senate Bill Introduced to Address Noncovered Services Issue

  • by AGD Washington Advocacy Representative
  • Nov 19, 2020
On November 12, Sens. Joe Manchin (D-WV) and Kevin Cramer (R-ND) introduced S.4894, the Dental and Optometric Care (DOC) Access Act, which helps ensure fairness in contracts between doctors and dental insurers and supports a healthy doctor-patient relationship. This is the first time a dental non-covered services bill has been introduced in the Senate.

The legislation would allow dentists to charge an amount that is usual and customary for services not covered under an insurance plan rather than the insurer's mandated fee schedule. Additionally, it will limit plan contracts to two years, unless a dentist chooses to extend the contract for another term and includes a private right of action provision that allows individual doctors to take offending plans directly to court.

Reps. David Loebsack (D-IA) and Buddy Carter (R-GA) have introduced a similar version of the DOC Access Act (H.R.3762) in the House. The DOC Access Act has substantial bipartisan support. The effort to advance the bill in this Congress is being spearheaded by the American Dental Association (ADA) and the American Optometric Association (AOA).

Impact on General Dentistry: AGD is pleased the DOC Access Act has been introduced in the Senate and strongly supports the legislation. Historically, insurance providers have mandated through agreements that doctors must charge patients for services and materials that are not covered under vision or dental plans regardless of the usual and customary rate. These charges set by the insurance provider's fee schedule often do not cover the service or operation's full cost. This legislation will bring better practices and free-market principles back into the healthcare system and ensure fairness in dentists and insurers' agreements.