2024 Dental Insurance Reform 

New dental benefit legislation filed by the Tennessee Dental Association was enacted by the Tennessee General Assembly earlier this year. The new law takes effect July 1, 2024 and addresses downcoding, bundling and virtual credit card issues. Additionally, the law adds penalties to violating these and the current non-covered services law enforceable by Tennessee Department of Commerce and Insurance (TDCI).

HB949/SB677 was sponsored by Senator Shane Reeves (R-Murfreesboro) and Representative Clark Boyd (R-Lebanon). To view the law in its final form, click the button below. 

View Law

Key Provisions of this Law:

  • Prohibits dental insurers from maintaining a plan that uses downcoding in a manner that prevents a provider from collecting the fee for actual services performed either from the dental benefit plan or the patient.
  • Prohibits bundling in a manner where a procedure code is labeled as nonbillable to the patient unless the procedure code is for a procedure that, under generally accepted practice standards, may be provided in conjunction with another procedure.
  • Addresses virtual credit card payments by preventing dental benefit plans from containing restrictions on methods of payment from the plan or its vendors to the dentist in which the only acceptable payment method is with a credit card. 

VIEW SUMMARY

 

How to File Complaints

Complaints about insurance providers can be submitted to TDCI using this Online Complaint form provided by NAIC. Contact the Consumer Insurance Services Section at (615) 741-2218 or 1-800-342-4029 with any questions pertaining to filing a complaint.

Online Complaint Form

 

The Tennessee Dental Association does not render legal advice or opinions to individual members or other affected parties. This executive summary should not be relied upon as providing full details of the new law. The TDA strongly encourages individuals to consult personal legal counsel for a complete understanding of the features and impact of this legislation.

 

 

Understanding the Key Issues

Downcoding and Bundling Services

Downcoding and Bundling Services

Insurance companies are financial entities with the job of facilitating payment, not practicing dentistry. Downcoding and bundling are examples of dictating what care patients receive based solely on price. Too often they dictate the cheapest procedure, not the proper patient care. When insurance companies “downcode,” they alter a dentist’s claim form, changing the service the dentist actually performed to a less complex service; when they “bundle” services, they group distinct healthcare services performed into a single billing code — both of which result in decreased reimbursement for the dentist. This law prohibits downcoding when it’s abusive, and establishes transparency over the process, without limiting insurers’ ability to make adjustments to claims when needed.

Virtual Credit Cards

Virtual Credit Cards

Insurance companies can require dentists to accept claim payments electronically and include a per-transaction fee of as much as 5%. Efficiencies gained by the insurance company shouldn’t come at the expense of patients. This law requires insurance companies to provide options on how to accept payment, with or without fees, that all parties knowingly agree to from the outset. 

Non-Covered Services/Capped Fees

Non-Covered Services/Capped Fees

Insurers offer benefit plans to employers or individuals which often do not cover every oral healthcare service. Dentists’ fees for services not covered by plans are often capped by insurers. By Tennessee law, plans cannot cap fees on services they do not cover. This law sets penalties for violating the law (TCA § 56-2-305).

 

Previous Dental Insurance Reform Initiatives

Massachusetts Ballot Initiative - Question 2

Massachusetts Ballot Initiative — Question 2

Massachusetts voters overwhelmingly approved Ballot Question 2 in a decisive landmark victory for dental patients nationwide. Passage of this measure is watershed moment for dental care and for important consumer protections for dental patients. Question 2 requires dental insurers to spend at least 83% of patient premiums on actual dental care instead of on executive compensation, corporate profits, and administrative costs.

Dental insurance plans that don’t meet the requirement of spending at least 83% of patient premium dollars on patient care now have to refund the difference to covered individuals and groups.

The ADA, the Massachusetts Dental Society (MDS) and dental care providers across the country led the fight for this important victory for patients despite millions of dollars spent by the insurance industry to oppose these critical consumer protections.

Ultimately when voters considered the facts, they overwhelmingly agreed that patient dollars should be spent on patient care and that these important insurance reforms were long overdue.

Together We Scored A Victory

The TDA contributed $10,000 in support of Massachusetts Ballot Question 2 and matched contributions made by Tennessee dentists up to an additional $10,000. Thank you to everyone who contributed to this effort. We are excited to work toward bringing these important benefits and consumer protections to dental patients in Tennessee.

Additional Resources