How to Eat an 800# Gorilla

I have often commented that most vision plan’s contractual requirement that providers extend a discount for all services, regardless of coverage, is both patently unfair and a brand-destroyer.  Well, apparently our friends in dentistry have seen the light.  Dentistry appears to have their act together on this issue and optometry can take a lesson from their efforts.  What follows is a legislative report from the American Dental Association.

ADA State Legislative Report – Dec. 2011 / Jan. 2012
Issue

Non-Covered Services

 Twenty-four states filed a bill in 2011 to limit or prohibit dental benefit plans from capping the fees a contracting dentist may charge for non-covered services. Ten of them enacted their law this year (Arkansas, Connecticut (sec 19), Georgia, Maryland, Minnesota, New Mexico, North Dakota, Tennessee, Texas and Wyoming). Bills are pending in Wisconsin, Pennsylvania and Massachusetts.

As mentioned a few months ago, a significant milestone was met in June when the 25th state (Texas) enacted a non-covered services law. Just a few weeks later, Connecticut became the 26th state to enact an NCS law. Now, over half the states have such a law in just two years of campaigns to
achieve the enactments. Always worthy of repeating, nearly all of the votes on NCS bills have been unanimous.

Opposition has historically come from insurers, though sometimes not as vehement as opposition from unions, particularly state employee unions, and small business interests in some states. The basic message in opposition has been one where costs would increase for consumers. State dental associations were able to explain that the costs would not really rise, but would be set at the dentists’ regular rate. Concerns over cost shifting to uninsured also resonated on some state advocacy campaigns.

Some plans are offering dentists the option to sign (or otherwise select) a capped fee contract for non-covered service fees. Although the particular states where this is a trend actually have an NCS law prohibiting plans from capping non-covered service fees, the plans offer that very option
to dentists.

The ADA is following this trend very closely and will keep you posted.

While our friends at the AOA have a lot on their plate and a taking up the fight directly with VSP, it seems that state associations have an opportunity at the local level.  I’m told that several states are working on this very issue and that success is expected.

So, while you can’t ignore the 800 pound gorilla, I do believe that you can destroy him the same way he was built…one state at a time.

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