January 9 marks the beginning of the 2019 General Assembly Session. What is on the VDA’s agenda this year? At our request, Delegate Lee Ware has introduced HB1682 that would require transparency when insurance companies lease networks. We are asking legislators to support fairness and transparency in dental contracts and avoid surprises for patients.
Background: The VDA Board of Directors approved the Council on Government Affairs’ recommendation to pursue legislation to be introduced in the 2019 VA General Assembly that will address problems associated with leasing networks and what some refer to as ‘Silent PPOs.’
A PPO is a type of health plan that contracts with providers (in this case dentists) to create a network of participating providers. PPO enrollees use a provider in the plan’s network and pay an agreed upon amount for selected procedures. In a “silent PPO” the original plan rents its provider network to other payors of dental services (insurance companies, self-funded plans, or others) with whom the dentist never signed a contract – often without the dentist’s consent.
Without the proactive notification and simple transparency measures that our legislation would provide, this practice is problematic for patients and the dental profession because, in some cases, the rental agreements take place without the dentist’s knowledge or consent. Since the dentist may be unaware of the arrangement, accurate cost and benefit information cannot be provided to the patient at the time of service. This may cause the patient to forgo benefits and treatment to which they are entitled. This also poses a dilemma for dentists as in some cases they end up being contracted to provide services in a network they never joined and often do not find out about the contract until they receive payment from a 3rd party claiming the discount.
WHAT IS THIS LEGISLATION ATTEMPTING TO DO?
The Virginia General Assembly prohibited silent PPOs by Worker’s Compensation carriers. This legislation does not prohibit any contract transactions; it simply provides fairness & transparency by adding the following five common-sense provisions:
- PROACTIVE Provider Notification -- the carrier must notify (via first class mail or electronically if agreed to in advance) all affected providers that their participating provider contract is being rented or sold to a third party.
- FRONT END Patient Notification – carriers must identify on the beneficiaries’ ID card those network leasing/sharing arrangements in which the payor participates – allowing the dentist to give accurate benefit info BEFORE treatment.
- BACK END Notification to Providers and Patients – carriers must ensure that an explanation of benefits (EOB) furnished to the participating provider identifies the contract source relied upon to discount reimbursement to the provider.
- ADHERANCE to Fee Schedule – the silent PPO carrier must abide by the fee schedule set forth in the original contract.
- MANDATORY ACESS to All Network Patients – any carrier that utilizes a silent PPO network must include all provider directories, advertising, websites, etc. as it does with directly contracted providers.
We need the VDA membership to help!
You can make an impact!
- Contact your legislators today and ask that they support HB1682 and sign on as a co-patron. Delegate Lee Ware (R-Powhatan), who carried our original non-covered services bill, has agreed to carry this legislation. We do not plan on having a Senate bill but that could change depending on the dynamics going into session. If you are contacting a Senator, please ask him/her to co-patron the House bill.
- How should you communicate with your legislators?
- Email or mail a personal note to your legislators asking for their support of HB1682, which can be referenced online at https://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+HB1682 and talking points, which you can access HERE.
- Request a meeting with your legislators and meet with them- schedule a visit with them in Richmond or back in the district. Share the information on HB1682 with them during the meeting.
- Call your legislators' offices and ask to speak with an aide or assistant to share the bill information with them over the phone
Need Assistance on finding your legislators and contacting them?
More Information on Advocating in Virginia
A helpful "Citizens Guide" can be found online at https://www.vpap.org/general-assembly/citizens-guide/
We look forward to seeing and hearing from you as we work together towards a positive result through the 45-day General Assembly session. Thank you for being a part of this important effort!
Questions? Contact Laura Givens at firstname.lastname@example.org or 804-523-2185.