April 22, 2015

The Honorable Anne Gonzales

Chair, House Health & Aging Committee

77 S. High St.

13th Floor

Columbus, OH 43215

Sent via email

RE: Ohio House Bill 95 – Non-Covered Services (NCS)

Dear RepresentativeGonzales:

United Concordia Companies, Inc. (“United Concordia”) appreciates the opportunity to offer comments on House Bill 95 regarding fees for non-covered dental services (“NCS”). United Concordia is one of the nation’s largest dental insurers, serving more than 7 million members worldwide. We operate eleven subsidiary companies licensed to transact health insurance and/or dental managed care in all fifty states and the District of Columbia.

As House Bill 95 is beingfinalized, United Concordia offers the following comments and recommendations regardingthe requirements proposed for fees for non-covered dental services:

  • The National Conference of Insurance Legislators (“NCOIL”) aids legislators in making informed decisions on insurance issues that affect their constituents. In November 2010, with the input from many stake holders, the NCOIL finalized model language that prohibited provider contracts from requiring a dentist to accept certain fees for NCS. Following the NCOIL NCS model language in part, HB 95 expressly prohibits dental plans and dentists from voluntarily negotiating and agreeing upon the terms of their business contract regarding the fees for NCS. This type of payment arrangement is common in many dental carriers’ provider contracts because it serves to limitthe cost of dental care for plan enrollees when they need services that the purchaser/employer may have chosen not to cover in an effort to control plan costs. Dentists knowingly and voluntarily enter into contracts with these provisions in return for the increased patient volume that comes from joining a dental plan network. By prohibiting dental plans and dentists from voluntarily negotiating fees for NCS, HB 95 inhibits the freedom of plans and dentists from entering into contracts to successfully serve their business needs. For this reason, we would respectfully recommend that Ohio refrain from adopting language that limits a dentist’s ability to agree to fees for NCS.
  • Transparency is instrumental in gaining and keeping members in a dental plan and maintaining and growing patients in a dental practice. Prohibiting contracted fees for NCS creates a barrier to cost transparency for members and patients by not providing a clear price for certain procedures. Not knowing the actual cost of a procedure creates risk for the wellness of the individual who decides against having a procedure because they do not know its cost. Prohibiting contracted fees creates uncertainty for individuals and families and is financially burdensome. Dental consumers, dental plans and dentists have a responsibility to work together to offer transparent and competitive costs for dental services. The current language in HB 95 would negatively impact transparency and cost controls.
  • Although the definition of “covered dental services” in HB 95matches the NCOIL model language, HB 95 varies from the NCOIL model, which has been adopted by many other states. First,HB 95 places the NCS prohibitions in the Unfair & Deceptive Acts section of the Insurance Code. Because NCS statutes deal with health care contracts between insurers and providers, we would respectfully suggest that the proposed language be better suited in the Health Care Contracts chapter of the Insurance Code. Second, its language would create an absolute prohibition againsta dental plan and a dentist agreeingto set fees for NCS. Such a proposed prohibition will be detrimental to the dental industry for dental plans, dentists, and the consumer for the reasons discussed above. We urge the committee to protect the business interests of dentists, the financial interests of patients, and the negotiating freedoms of dental plans by revising HB 95 to allow freely negotiated fees for NCS in dental network participation agreements.

We appreciate the opportunity to comment and your consideration of our recommendations on HB 95. We encourage the Committee to fully investigate the ramifications this bill may have on their constituents and employers in the state. We are available to answer any of the Committee’s questions. Please feel free to contact me with any questions at 717-260-6900 or .

Sincerely,

James B. Bramson, DDS

Chief Dental Officer

Cc: Members of the Health & Aging Committee

Rep. Stephen Huffman, Vice Chair

Rep. Nickie J. Antonio, Ranking Member

Rep. John Barnes, Jr.

Rep. Heather Bishoff

Rep. Tim W. Brown

Rep. Jim Butler

Rep. Christie Bryant Kuhns

Rep. Nicholas Celebrezze

Rep. Mike Duffey

Rep. Timothy E. Ginter

Rep. Terry Johnson

Rep. Sarah LaTourette

Rep. Michele Lepore-Hagan

Rep. Ron Maag

Rep. Dan Ramos

Rep. Kirk Schuring

Rep. Barbara Sears

Rep. Robert Sprague

Rep. Emilia Strong Sykes

Rep. Clifford Rosenberger, House Speaker

Rep. Fred Strahorn, Minority Leader

Legislative Aide Chris Corder

Legislative Aide Nick Derksen