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VDA Silent PPO Legislation Enacted on July 1

Transparency that will Help you Better Run Your Business and Serve Your Patients

HB1682, the bill that was introduced by Delegate Lee Ware at the request of the VDA, was enacted into law on July 1st. This law establishes limits on the ability of a health carrier or third-party administrator to sell or lease a dentist’s contract to another third party carrier.  The carriers must now must first provide notice to the participating dentist.   

What are the new requirements that will now provide participating dentists and patients with transparency?

This law 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 payer 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.
  • ADHERENCE to Fee Schedule – the silent PPO carrier must abide by the fee schedule set forth in the original contract.
  • MANDATORY ACCESS 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.

A copy of the legislation, as passed, can be found here. Thanks to all VDA members and those in the dental community who helped advocate for the passage of this legislation.  It was largely due to members reaching out to their legislators that this bill was able to pass with no opposition.  Another big step to help better run your businesses and serve your patients!