dentist to another entity, com- monly referred to as “network leasing”. The way the current law is written, insurance car- riers are only legally required to notify the dentist after the fact by giving them an “opt out” option. Our legislation would have updated this law to require health insurance carriers, including pre-paid dental plans, gain written consent from the participating provider regarding the leasing or any change to their network plan.
Despite many conversations and back and forth with the dental insurance companies, we were ultimately unable to agree upon bill language that would suit all parties. Such op- position was not unexpected. During the interim, we will continue discussions with interested parties in hopes we can find mutual language ahead of the start of next year’s legislative session.
Thank you all for another wonderful year serving as your Legislative Liaison. Our successes are only possible because of members like you, and your commitment to advancing and protecting this profession. For more informa- tion about our 2022 legislative successes and how you can help us prepare for 2023, visit
modental.org/advocacy.
SAVE THE DATE
The 2023 Virtual Town Hall will be February 1 and Dental Day at the Capitol will be March 1. Place these dates on your calendar!
Contact Olivia Wilson, MDA Legislative Liaison, at olivia@molobby. com.
What Good Are Rules If Not Followed? T
by PAUL O’CONNOR
hat question has been bothering us in the advocacy world, and
we recently took steps to start addressing it. Over the last few years, the MDA has led the way on needed dental insur- ance reforms to help solve the day-to-day problems dentists and patients experience with insurers. But how are we sure all laws are being enforced? That question brought the MDA and ADA to the state’s top attorney to discuss insurer compliance and accountability.
On March 28, the MDA met with Attorney General Eric Schmitt’s staff to discuss dental insurer accountability. As many dentists in Missouri and across the country know, working with insurers is becoming increas- ingly exasperating. The rules incrementally shift in favor of the insurers, necessitating legislative protections in many cases. Despite claims of being ‘for-the-patient,’ insurers are in business to make money. When insurers’ profit motive impacts patient care, the dental profes- sion has a duty to act. Insurers’ interference with patient care is dentistry’s motivating factor in pursuit of reforms, which includes the pursuit of ensuring more accountability as well. This is the primary reason the MDA asked for an audience with the state’s Attorney General.
General Schmitt’s top staff joined MDA’s President, Dr. Tom Stone; President-Elect, Dr. Jeremy Bowen; and, Legislative & Regulatory Chair, Dr. Ron Wilkerson, for a robust conversa- tion that focused not only on enforcement of existing laws,
but the reasons the laws had to be passed in the first place. MDA staff and lobbying team, Vicki Wilbers, Jorgen Schlemeier and Olivia Wilson, offered valuable insight into the coverage trends and how they impact access to care. The ADA joined with our consultant Dusty Brighton to give the national perspective and offer ideas on how the Attorney General might address members’ enforcement concerns.
Insurance is a language all its own. The various operations like downcoding and bundling are not immediately clear for those not navigating the processes daily. Much of the meeting with the General’s staff involved explaining these operations and how they negatively affect practices’ abilities to focus on patients. The MDA developed a number of resources for the meeting, including survey results and personal stories from MDA dentists. The stories from members collected through the survey were essential in illustrat- ing the real impact of insurance problems and underscore the concerns about enforcement.
As we rolled through the issues, Virtual Credit Cards got a lot of attention. The MDA gave great examples of why the law was needed in the first place, noting the additional cost when insurers limit claim payments methodol- ogy to credit cards only. The dentists explained how difficult it is to manage accounting for individual patient services under the virtual credit card payment system. While the MDA and its members worked hard to pass protections against insurers limiting payment to credit card only, dentists still have to remind
insurers they’ve chosen non- credit card options. This proved to be a great example showing the need for more oversight on the laws passed.
Progress on dental insurance legislative solutions can be incremental, but MDA has been very successful in pushing dental insurance reforms. Member- ship plays a key role in passing, protecting and enforcing laws like network leasing transpar- ency, required payment on insurer-authorized services and limitations on fee-based virtual credit card claim payments. The power of strong membership fuels the advocacy motor that is necessary to get and keep these laws on the books. But if insurers are able to ignore the new laws without ramifications, that adds a whole new layer to advocacy. The MDA/ADA partnership put that concern squarely before the state’s executive branch whose job it is to enforce laws passed.
“Looping General Schmitt’s staff in on enforcement issues will help add a better foundation for the laws the MDA has worked to pass and will add more stability for dental practices navigating the sometimes-choppy waters of dental insurance opera- tions,” said Dr. Stone. “Improved oversight will help patients who rely on their dentist for the most appropriate care that is delivered in the right way and provided at the right time.”
Paul O’Connor is Senior Legislative Liaison, ADA State Government Affairs.
ISSUE 3 | MAY/JUN 2022 | focus 17
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