June 21, 2021
Editor’s notice: Dental Insurance coverage Hub is a collection aimed to assist dentists and their dental groups overcome dental insurance coverage obstacles to allow them to give attention to affected person care.
The Competitive Health Insurance Reform Act, laws that repeals the McCarran-Ferguson antitrust exemption for medical insurance firms, grew to become legislation on Jan. 13.
The legislation is the fruits of a multi-year effort by the ADA and dentists to influence Congress that well being care insurance coverage, together with dental plans, ought to not be protected against among the federal antitrust legal guidelines.
So, the query is, what occurs now?
The brand new legislation, geared toward enhancing transparency and competitors within the well being, dental and imaginative and prescient insurance coverage marketplaces, was lobbied by the ADA in hopes that this can lead the Federal Commerce Fee and the Division of Justice to research alleged anticompetitive practices and actions of well being care insurers, mentioned David White, D.D.S., chair of the ADA Council on Authorities Affairs.
“With the brand new legislation’s clear message that there is no such thing as a foundation for persevering with the exemption, we hope that the FTC and DOJ will now examine suspected anticompetitive conduct and pursue sanctions when it’s discovered,” Dr. White mentioned.
The primary rationale for the McCarran-Ferguson Act, when it was adopted in 1947, was to have states handle the regulation of the enterprise of insurance coverage. Due to this fact, Dr. White mentioned, the FTC and DOJ could have been hesitant to proceed in opposition to insurance coverage firms, even when their conduct was not protected underneath the restricted exemption. One other facet which will have cooled any investigations was insurance coverage firms claiming McCarran-Ferguson exemption in protection of antitrust allegations, he added.
For instance, earlier than the exemption was eradicated, Delta Dental asserted it as a protection to the pending class motion lawsuit in opposition to the corporate during which the ADA is a plaintiff.
Shopper Studies, which has lengthy advocated for the reform laws, praised the passage of the invoice as being good for each customers of well being care companies and suppliers. On Dec. 22, 2020, Shopper Studies wrote “the antitrust exemption has basically allowed well being insurers to behave as a monopoly, making calls for in lockstep on the phrases they are going to provide customers and healthcare suppliers. The ensuing squeeze places stress on suppliers to chop corners on service with a view to enhance the income the well being insurers can extract.”
On the May 17 episode of the ADPAC and ADA podcast Tooth Discuss, the featured visitor was George Slover, senior coverage counsel with Shopper Studies.
The ADA has developed an FAQ in addition to a one-page summary for ADA dentists with questions on how this legislation will have an effect on dentists and dental practices.
The ADA has a brand new on-line hub for ready-to-use dental insurance coverage info that may assist dentists tackle and resolve even their most irritating questions at ADA.org/dentalinsurance.