Oregon lawmakers are advancing a bill intended to stop insurers from blindsiding dentists with unexpectedly low payments.
House Bill 3008 targets little-known practices that the bill’s supporters say hurt not just dentists but their patients. It limits the ability of insurers to pay dentists reimbursements with credit cards, which carry fees that add up. It also restricts insurers from leasing dentists out to other provider networks. The practice involves insurance companies contracting with other health plans. The health plans get access to the insurer’s providers at a discounted rate.
The bipartisan bill passed the Oregon House in March with no opposition and had its first hearing in the Senate Health Care Committee Wednesday.
State Rep. Hai Pham, a Hillsboro Democrat who co-sponsored the bill, told The Lund Report that the bill targets insurance practices that occur without the consent of dentists and are resulting in unexpectedly higher copays for consumers and lower reimbursements for providers.
“The consumer could have a totally different copay, or reimbursement rates are totally different (for dentists),” said Pham, a pediatric dentist.
Currently, dentists must ask insurers to exclude them from contracts that lease out their services at a discounted rate to other provider networks — they are included by default.
Dr. Mark Miller, board president of the Oregon Dental Association, told The Lund Report that the bill targets insurance practices that may result in a situation where a patient thinks their insurance will cover $500 towards a crown when only $400 is covered, with the rest of the cost showing up in their bill.
“Dentists aren’t aware that this is going on until they see the reimbursements are less than the quoted fees were going to be,” he said. “And then dentists are upset and the patient’s upset because neither one of them gets to maximize their benefits.”
The bill seeks to remedy the situation by requiring explicit agreement before a dentist can be leased out to another provider network.
The bill would still allow insurers to pay reimbursements using a credit card, but they would have to notify the dentist in advance of any potential fees and offer an alternative payment method.
Dr. Noel Larsen, a Portland pediatric dentist, described in draft testimony she intends to submit to the Senate Health Care Committee how she’s lost money as insurers have shifted to credit cards to pay reimbursements, rather than using checks. A few years ago, her office lost approximately $750 annually to credit card processing fees. In 2021, her office paid $8,000 in credit card fees and $11,000 the next year.
“And it turns out I’m lucky compared to other dentists,” she wrote in the testimony, which was shared with The Lund Report. “My office works with a relatively small number of insurance companies, and our accountants said those credentialed with a larger number of insurers have seen much larger losses. What’s more, dentists are often unaware they will be reimbursed this way until after the fees have been incurred.”
The National Association of Dental Plans, the insurer trade association AHIP and the American Council of Life Insurers submitted testimony to a legislative panel in February indicating that they were neutral on the legislation. The groups’ testimony argued that leasing providers’ services benefits consumers while helping meet state and federal requirements ensuring networks are adequate.
“We are certainly willing to work with dentists about opt-out provisions and make these provisions easier to understand,” Elise Brown, a lobbyist for AHIP, told the Oregon House Behavioral Health and Health Care Committee in February.