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Do you know what is going on regarding your money?

Doctors stand up and know what is going on. You ask why are the DSO’s doing so well? I hear this at every conference I teach at. Some of the reasons are the way they are running the dental offices, (as a business) some of the ways are more dentists who are tired of trying to run the business and only want to provide treatment, and finally they have a team who not only finds out information before you do, but are involved in Washington making and asking for different laws and ways to help practices. Ask yourself, are you even aware of what is happening?

One of the big issues is a drafter of a new dental insurance standards proposal who has borrowed an idea from the medical doctors: a ban on insurer efforts to pay providers solely through credit card transfers.

North Dakota state Rep. George Keiser, R-Bismarck, has included a payment method provision in a Patient Dental Care Bill of Rights model law draft under discussion at the National Council of Insurance Legislators (NCOIL).

Members of NCOIL’s Health Insurance & Long-Term Care Issues Committee talked about the proposal Wednesday in Austin, Texas, at NCOIL’s annual meeting.

NCOIL is a group for state-level senators, representatives and assembly members who have an interest in insurance. It cannot change state laws itself, but members or others can start with NCOIL models, or batches of sample language, when creating their own bills and regulations.

Keiser’s current dental insurance standards draft includes provisions related to dental provider networks, dental insurers’ payment guarantees, dental insurer spending disclosures, and moves by insurers to deny payments for care after care has been approved and provided.

The payment method provision resembles major medical insurance payment method laws adopted in Oklahoma, Arizona and other states in recent years.

The provision would prohibit a dental plan from making plan payments to a dentist via virtual credit card payments the only way for a dentist to be paid.

If a plan did pay a dentist via virtual credit card payments, or types of electronic fund transfers, the plan would have to tell the dentist about the fees associated with a payment method and explain how the dentist could choose another payment method.
The insurer would also have to tell the dentist if the insurer was sharing part of the credit card company’s fee revenue.

The law that was passed in Arizona is the following:

  • The new law is set to affect provider contracts issued, amended or renewed in the state on or after Jan. 1, 2020.
  • The new law will apply to contracts issued, amended or renewed in Arizona on or after Jan. 1.

In addition, the new law precludes health insurers in the state from charging a fee solely to send payments to a health care provider without the provider’s consent. The law does permit health care provider agents to charge “reasonable fees” when transmitting funds via electronic transfer or automatic clearing house “related to transaction management, data management, portal services and other value-added services above and beyond the bank transmittal.”

HB2494 also requires insurers to notify health care providers of any fees associated with payment methods.

Contact your state House of Representatives to find out what they are planning to do!

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