G ove r n men t Re lat ions
PDA Achieves Legislative Milestone
Assignment of Benefits Bill Takes First Step in
Legislative Process
PDA has lobbied for years for the passage of assignment of
benefits legislation, which would require insurers, on patients’
request, to assign benefits directly to dentists, even if they are
non-participating providers. On October 24, 2017, PDA
accomplished a monumental task while contending with
intense opposition from insurance lobbyists. The Senate Banking
and Insurance Committee passed SB 373, PDA’s assignment of
benefits legislation, with a vote of 9-6.
The fight is far from over. PDA expects the insurance lobby to
ramp up its efforts to “kill” the bill as SB 373 moves to the
Appropriations Committee for consideration, then the full Senate
for a vote. Action on your part is necessary to pass this bill in
the Senate and send it over to the House of Representatives.
The insurance industry has many lobbyists and deep pockets.
But the voice of organized dentistry is thousands strong, and
represents both dentists and patients. Senators just need to
hear from all of you, and they need to hear from you soon. If
they don’t, your state senator will assume this legislation is not
important to dentists, and there is a good chance the insurance
lobbyists will prevail and that SB 373 will not move any further
in the legislative process.
Your senator just returned to Harrisburg to conduct legislative
business. Now is the perfect time to call or email your senator’s
Harrisburg office to ask for his or her support for SB 373. Give
them the reasons why Pennsylvania needs assignment of benefits
legislation (see below) and ask them to vote “yes” on SB 373.
Need your senator’s contact information? Contact the
government relations staff at (800) 223-0016, extension 108, or
at [email protected]. Or log on to www.legis.state.pa.us and
search under “Find My Legislator.”
TALKING POINTS: REASONS TO ENACT ASSIGNMENT
OF BENEFITS
n Some patients cannot see their dentist of choice because
some insurance companies do not directly pay the
non-participating provider and they cannot afford to pay
for services upfront. Dentists who do not require advanced
payment may never be paid for services rendered. This
insurance practice unfairly inhibits patients from seeking
care from their dentist of choice, even though they are
paying for a benefit that should be applied to any provider,
regardless of whether or not the provider participates with
the patient’s insurance plan. The insurance is a purchased
product and belongs to the patient.
n This bill helps more patients access dental care. Patients
residing in rural areas are placed at a disadvantage as there
may only be a handful of dentists who are in-network.
Patients may have to incur more traveling time and expense
to seek treatment from an in-network provider, rather than
being treated by a non-participating dentist who practices
in closer proximity.
n Absence of assignment of benefits legislation forces patients
to pay upfront for treatment they may not be able to afford.
This can be particularly difficult for divorced or separated
parents, single parents and low-income families. It would be
much easier for a patient to have the ability to assign the
dental benefit directly to the provider.
n Parents who are divorced or separated may experience the
problem where one parent has custody of a child while the
other parent carries the insurance. The latter may never send
the insurance check to the custodial parent, who had to pay
for services upfront. Faced with this situation, many custodial
parents postpone or avoid care altogether. This could also
impact the dentist, who sympathizes with the parent and
sees the child without requiring advanced payment. Often
these dentists are never paid.
n A study from the Indiana Health Law Review, found that
assignment of benefits laws do little, if anything, to increase
health care costs. In fact, ensuring that providers are paid
results in them continuing to provide care without having
to raise their rates. Another advantage is the elimination
of many of the administrative hassles associated with billing
and payment experienced by both providers and patients.
Access the full study at: http://journals.iupui.edu/index.php/
ihlr/article/view/16584.
n Insurance companies oppose assignment of benefits laws
because they feel this will weaken the participant network.
Empirical evidence does not substantiate the claim that
provider networks are weakened in states with assignment
of benefits laws. Most recently, a study from Florida after it
enacted assignment of benefits legislati on found no net loss
in physicians’ participation in network plans. Access the full
study at: https://www.padental.org/Images/OnlineDocs/
Advocacy/DayOnTheHill/FL_networkParticipation.pdf.
n 23 other states have enacted assignment of benefits laws.
Please contact PDA’s government relations staff at (800) 223-0016
with any questions or concerns.
JAN UARY/FEBRUARY 2018 | P EN N SYLVAN IA DEN TAL JOURNAL
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