ADA presses Congress for greater oversight of dental payers: 6 notes

The American Dental Association is urging Congress to strengthen oversight of dental insurance markets while ensuring that fraud prevention and competition policies do not impose unnecessary burdens on independent dental practices.

Six notes:

1. In comments submitted to the House Judiciary Subcommittee on the Administrative State, Regulatory Reform, and Antitrust, the ADA called for dental insurance markets to be included in broader discussions of healthcare competition. An analysis from the Government Accountability Office found that the three largest stand-alone dental insurers collectively held 38% to 97% of the group market across states, reaching at least 80% in 11 states.
2. The ADA raised concerns about network leasing, saying shared-network arrangements are not inherently harmful but that extending a dentist’s contracted rates to additional entities without clear disclosure and affirmative consent creates confusion for dentists and patients. 
3. On ERISA, the ADA said carriers and third-party administrators have at times asserted federal preemption to avoid state dental insurance protections that apply to fully insured plans. The ADA supports clarifying that state laws regulating the provision and payment of dental care are not displaced simply because a carrier administers a self-funded plan.
4. The ADA called for improved dental-specific reporting on Medicare Advantage supplemental dental benefits, noting that 52% of beneficiaries selected their plan based on the inclusion of a supplemental dental benefit. It also urged greater automation of dental administrative transactions in Medicare Advantage, including standardized electronic eligibility and benefit verification.
5. On fraud-prevention, the ADA said AI-based claims reviews should include appropriate validation, transparency, appeal rights and human review. 
6. The ADA cautioned against applying policies targeting large consolidated health systems to independent dental practices, saying the two should not be conflated when Congress considers remedies aimed at provider market power.

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