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Dental Insurance Reform a Key Component of the ISDS 2023 Legislative Agenda

The 2023 legislative session began with the inauguration of legislators on January 11, 2023. Legislators and advocates are now developing their agendas for the 2023 session, and we would like to announce ours. This year, we will focus on a key issue you face when you practice: dental insurance reimbursement.

ISDS members: To stay up to date on our efforts, please sign up for our text alerts by clicking here.

In addition to dental insurance reform, this year’s agenda also includes a dental practice initiative focused on teledentistry as it relates to your practice and a change to the Medicaid program that will require the adoption of the American Association of Orthodontics standards for automatic qualifiers for patient eligibility.

Dental Insurance Reform 

ISDS regularly hears from our members about numerous issues they have with dental insurance companies. The 2023 legislative agenda includes the following dental insurance reform measures:

  • Dental Loss Ratio: Medical insurers are required to spend a minimum amount of the premium dollars they collect on patient care, called a medical loss ratio. This type of standard does not currently exist for dental care. This allows dental insurers to spend as much or as little as they want on patient care and administrative expenses.

ISDS is seeking the passage of legislation requiring dental insurers to meet a dental loss ratio. This would require dental insurers to spend a minimum of the premium they collect on patient care. Patients should have more of their premium dollars spent on the dental care they need, not the insurer's administrative expenses.

  • Network Leasing: Insurance companies will sell or lease their network to another company, requiring the dentist to abide by the new network's fee schedules and contract terms. This often happens without the consent of the dentist. ISDS is seeking legislation requiring the insurance company to obtain the dentist's permission before the leasing of the network. Thus, allowing the dentist to choose if they would like to be enrolled in the new network.
  • Electronic Payment Fee Processing Ban: Dental insurers have been utilizing a new payment method that is putting an added burden on dental offices. The insurers pay the dentist with a virtual credit card. When the dentist receives this payment, the insurer will require the dentist to pay the processing fee on the credit card. Thus, forcing the dentist to accept another decrease in the amount they are owed. ISDS seeks legislation prohibiting the insurer from requiring the dentist to pay the processing fee on any electronic payments, including virtual credit cards.

Teledentistry 

ISDS has been seeking to implement further patient protections for teledentistry in Illinois. Teledentistry needs to be a safe and effective treatment option for patients. ISDS has been working on this issue over the last year and will continue to do so throughout the 2023 legislative session. ISDS is seeking the passage of legislation that will require strong patient protections when a dentist chooses to use teledentistry.

Medicaid Program- Orthodontic Standards 

The Illinois Department of Healthcare and Family Services (HFS) does not currently have a standard or automatic qualifier for when a patient can receive orthodontic care. The lack of a standard has caused administrative obstacles and denial of claims for orthodontic care. The American Association of Orthodontics (AAO) established a committee that developed a comprehensive list of recommended auto-qualifiers and diagnostic documentation for medically necessary orthodontic care. ISDS is seeking the passage of legislation that would codify these standards in state law. This would help clarify the confusion created by existing administrative obstacles.

Legislators want to hear from you. They want to know how these issues affect your practice. Your involvement in our efforts will become very critical as we move forward. At the appropriate time during session, there will be action alerts sent to our members. Therefore, we will ask you to respond to those alerts and contact your legislators.

ISDS members: To stay up to date on our efforts, please sign up for our text alerts by clicking here.

As always, ISDS will keep our members informed as the session progresses, and we strive to move these issues forward.

 

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