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NCOIL Postpones Action on Dental Fees Model

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The National Conference of Insurance Legislators (NCOIL) will be spending more time working on a dental services fee schedule proposal.

Members of the Health, Long-Term Care & Health Retirement Issues Committee at NCOIL, Troy, N.Y., decided recently at the group’s summer meeting in Boston to change the proposal and keep working on it, officials say.

The proposed model would ban fee schedules for uncovered dental services, to keep dental plans from trying to control the prices of services the plans will not be covering.

The original version of the model would have prohibited “a dental insurance plan from requiring a dentist who provides services to its subscribers to accept a fee set by the plan unless the plan compensates the dentist for such services,” according to a draft released in November 2009.

Under the terms of the original draft, a dental insurer could have established a fee schedule for covered services, but it could not have imposed the fee schedule on services provided for patients who had not yet met their deductibles, or for patients who had used up their benefits.

Health committee members decided in the recent summer meeting to make the ban narrower, officials say.

The new, amended version would let insurers apply fee schedules to “covered services,” even if the insurers were not going to pay for the covered services.

The term “covered services” would be defined to include “services reimbursable under the applicable subscriber agreement, subject to such contractual limitations on subscriber benefits as may apply, including, for example, deductibles, waiting period or frequency limitations,” officials say.

The amended version of the proposal would prohibit insurers from leasing their dentist networks to other entities that set fee schedules for non-covered services, officials say.

Debate on the proposal was vigorous, and NCOIL has decided to get more input from business groups, labor groups and other interested parties, officials say.



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