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1 FINAL SLIDE WILL BE END OF VIDEO PRESENTATION ADDED AS A SLIDE.
2 System is Broken M-2 Patients being denied services Providers being denied payment Doctor-Patient Relationship erodes
3 Supply of Dentists M American Dental Association. All Rights Reserved. 3
4 M-4 From , dentists per 100,000 residents increased 16.7% - 3 rd highest in U.S. Nevada ranks 19th in the United States (2015); 31 st in 2011.
5 Reimbursement M American Dental Association. All Rights Reserved. 5
6 M-6 From , payments to Nevada dentists from insurance companies decreased 18%.
7 Dental benefit introduced in 1963 at $1,000 in coverage. M-7 54 years later in It remains at $1,000
8 What Does A.B. 213 Do? Streamlines the definition of a covered service, closing loopholes that allow dental insurance plans to avoid paying for services covered by a policy. Prevents a dental insurance plan from setting fees on services not covered within a plan. Prevents a dental benefit plan from setting a de Minimis Fee for services. M-8 Requires dental plans to notify to consumers about what is and is not covered in their dental policy. Requires dentists to notify patients of their usual and customary rates, UCR s. Allows the dentist to charge their UCR s after the annual policy maximum is met.
9 Current definition of a covered service: M-9 NRS 695D.227(3) - As used in this section, covered service means dental care for which reimbursement is available under a member s policy, or for which reimbursement would be available but for the application of a contractual limitation, including, without limitation, any deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment or any other limitation.
10 M-10 AB213 Proposed Definition: As used in this section, covered service means dental care for which reimbursement is provided on a dental procedure code published by the American Dental Association, or its successor organization, in the Code on Dental Procedures or Nomenclature Code, or any successor publication. Simple Understandable Better for Consumers and Providers.
11 Medical vs. Dental Insurance Dental insurance is a finite benefit.. $750 Annual Max - $31/month; $372 in premium. $1,000 Annual Max - $40/month; $480 in premium $1200 Annual Max - $43/month; $516 in premium. M-11 At year-end 2014, there were approximately 205 million Americans or 64 percent of the population with dental benefits [1]. *Ehealthinsurance.com *nadp.org
12 Example #1 The dreaded waiting period M-12 Patient went to dentist in pain with a toothache Dentist examines and decision to remove tooth is made. Insurance denies payment stating the plan only covers emergency evaluations when no other services are rendered!
13 Example #2: Insurance interference M-13 Patient needed treatment for gum disease The dentist treated the patient after determining that treatment was necessary Insurance denied payment, stating that gum disease treatment was only covered if bone loss was evident on X-ray X-rays only show if 30% of the bone is deteriorated from gum disease.
14 Example #3: Coordination of Benefits M-14 Patient has primary and secondary dental insurance Sees the dentist for $210 worth of dental work Primary insurance covers $152 Secondary insurance pays $0. Patient stuck with a $58 charge due to policy non-payment.
15 Dentists are just being greedy Average graduating student debt for dental school is $261,149.* Average cost of opening a dental office? $350,000-$550,000.** The first dental policy was offered by MetLife in The coverage amount was $1000. Today, the coverage amount is still $1, years later. M-15 In Nevada, Insurance Payment amounts to dentists have decreased 18% between Is it wrong to do what s in the best interest of the patient and expect to be compensated for services provided? * **howtoopenadentaloffice.com
16 Contracting M-16 If They Don t Like the Terms, They Shouldn t Sign the Contract. Not a realistic market option
17 This bill is anti-consumer and will raise costs M-17 Is allowing patients to access coverage they have paid for, and allowing patients and providers to determine the course of treatment anti-consumer?
18 M-18
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