In April, Colorado Gov. John Hickenlooper signed into law SB 190, a bill that requires dental plans to stop dictating fees for services they do not cover. This practice has been an ongoing concern for member dentists for many years, as it can disrupt patient choice of dental services and the patient-provider relationship. It can also interfere in fair delivery of dental services for patients across the state, creating cost shifting and barriers to care.
Today’s victory marks the end of years
of policy discussions on this topic and will offer
more flexible care options to dentists and their patients.
The passage of this bill sets in motion an important first step in broad conversations on insurance reform and the future of dental benefits that will be happening in coming years. The CDA remains committed to support reforms that ensure equitable treatment of dentists, preserve high quality care, and increase patient access to dental services.
SB 190: What You Need to Know
SB 190 prohibits dental plans from setting fees for services that are not ever covered by a patient’s specific plan. It does not change payment policies for covered services or for services that would be a covered service if the patient had not met a frequency limitation, a waiting period, an annual maximum, or similar covered service restrictions.
The bill took effect Aug. 9, 2017. The CDA is talking with dental plans and carriers to provide additional information on the practical effects and implementation of this bill in coming weeks.
Updates from Dental Plans
Cigna Dental: Cigna Dental recently reached out to its network dentists to communicate how it has changed its agreement based on this new law. To ensure compliance with this recent regulatory change, Cigna Dental has amended the PPO Dental Office Reference Guide to update the company’s administrative guidelines, which are incorporated by reference into provider agreements. Effective Aug. 9, 2017, Cigna Dental will not require dental providers to accept the contracted fee for services that are not covered by the customer’s benefit plan. Providers may verify covered services for each member’s plan by calling 800-244-6224 or accessing the Cigna for Healthcare Professionals website.
Delta Dental: Delta Dental recently reached out to new members to communicate how is plans to proceed, citing “Delta Dental of Colorado will comply with this new legislation in a manner that is consistent and easily understood.” The letter continues that “if a clinical situation can be managed with a procedure (actual or alternative) that is ever a covered service under your patient’s plan, the contracted fee for the procedure performed must be honored. We call this the “Never Ever Rule.” If you have questions about how this legislation will affect patient’s claims, contact Delta Dental of Colorado’s customer service at email@example.com or 800-610-0201.
Thank You for Taking Action
As we celebrate today’s victory, the CDA would like to extend special thanks to:
- bill sponsors Sen. Larry Crowder, Sen. Dominick Moreno, and Rep. Matt Gray;
- Government Relations Council chairs Dr. Ken Peters and Dr. Carol Morrow;
- Dr. Jason Ehtessabian, Dr. Marilyn Ketcham, Dr. Steve Nelson and CDA President Dr. Michael Varley who provided testimony on the bill;
- the dental plans and carriers that worked with us on SB 190; and
- the many CDA members who have contacted legislators in support of this issue.
Read the final version of the bill.
If you donated to the Colorado Dental Political Action Committee (CODPAC), you had a direct impact on this bill passing. Thank you for your support!
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