May 2019 Volume LIV Number 3

 
 
 
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Non-Covered Benefits Legislation

March 2016 Volume LI Number 2

 

Lawmakers in many states have passed new legislation that no longer allows insurers to require dental providers to give discounts for services not covered under an insured dental plan. 

While this legislation applies only to discounts on non-covered services under insured plans, and does not affect the policyholder’s current insured benefit plan(s), members in these states may no longer receive discounts on non-covered services and should discuss any available discounts with their dental provider.

As the legislation continues to progress in other states, please check back for any updates, especially for policyholders with members located in multiple states.

If a dentist signs a participating provider agreement with a dental plan that has this provision, and there are no state statutes to prevent it, then he/she may be contractually bound to only charge the patient the carrier’s maximum allowable fee for the non-covered procedure. AAPD staff has been continually working with state dental societies on non-covered services legislation and 35 states have passed legislation preventing third party carriers from capping what a doctor can charge a patient for a non-covered service. This means that the doctor could charge his or her full fee in this situation. If your state has not passed this type of legislation, it is recommended you contact your state dental society for assistance.

Visit http://aapd-oldsite.ae-admin.com/noncovered_services_laws/, to see the states that have passed this legislation and links to the actual laws.

For further information, please contact AAPD Dental Benefits Director Mary Essling at (312) 337-2169 or messling@aapd.org

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