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Delta Dental already compliant with new PA non-covered services law

Current claims processing guidelines aligned with SB 1144 since 2011

November 20, 2012

New dental-related legislation passed by the Pennsylvania state legislature and signed last month by Governor Corbett has no practical impact on Delta Dental of Pennsylvania claims payment policies or dentist contracts.

The legislation, SB 1144, was championed by the Pennsylvania Dental Association and carried by State Senator Kim Ward (District 39-Westmoreland County). Delta Dental supported the bill after working with Senator Ward to ensure the bill followed a model for such legislation endorsed by the National Conference of Insurance Legislators (NCOIL).

In brief, SB 1144 prohibits an insurer's contract with a dentist from requiring that the dentist provide services to covered patients at a fee set by the insurer, unless those services are “covered dentist services.” The definition of “covered dentist services” is key to interpreting how this bill might affect some Pennsylvania dentists under various contracts with some dental insurance companies. Covered dentist services are defined in the legislation as those services for which reimbursement is available under an insured’s policy, “regardless of whether the reimbursement is contractually limited by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation or alternative benefit payment.”

Delta Dental of Pennsylvania first implemented payment policies that adhere to the provisions of SB 1144 nearly two years ago, allowing dentists’ submitted claims to be paid in full by the patient whenever the service is one that is never covered, even in part, under the patient’s policy in effect. The company made this change in order to comply with similar policies already in effect (or soon to be) across the entire 15-state holding company system to which it belongs.

“Delta Dental has actively participated in helping state dental societies win similar legislation in California, Louisiana, Georgia, Maryland and Texas,” said Jeff Album, vice president of Public and Government Affairs. “So long as the definition of covered services closely hues to the NCOIL model, we think a level playing field across all dental insurers is a good thing, one that benefits both dentists and the competitive markets for dental insurance.”

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