HB 564: Assignment of Benefits

PDA ACTION ALERT

CONTACT YOUR REPRESENTATIVE AND REQUEST SUPPORT FOR HB 564, “Direct Pay” legislation

Last year, HB 564 was amended to include language from Act 68 of 1999, which requires insurers to promptly pay clean claims submitted by participating and non-participating providers. The practical application of Act 68 still does not ensure direct payment to non-participating providers, just that the insurer pay the clean claim promptly (payment can still go directly to the subscriber). Current interpretation of the existing law does not guarantee direct payment to non-participating providers, which means that it is still necessary for PDA to lobby for legislation.

PDA supports HB 564 as amended by the House Insurance Committee and retains the ability to amend the legislation in the future if necessary.

Now is the time to schedule a meeting or make a phone call to your Representative to request his/her support for HB 564 as amended. We need the House to vote on HB 564 as soon as it returns to Harrisburg in September. There are only a handful of session days left this year. 

We are now calling this "direct pay", not "assignment of benefits", legislation. Please use the talking points below to educate your Representative about why the bill was amended (to clarify an existing law) and how it is still a consumer-friendly bill that will improve access to dental care.

Need contact info for your legislator? Check out the General Assembly’s website at http://www.legis.state.pa.us. Or contact PDA’s government relations staff at (800) 223-0016 or mss@padental.org

HB 564 TALKING POINTS

HB 564, as amended by the House Insurance committee in June, simply provides clarification to an existing law. The original intent of Act 68 of 1999 was for insurers to pay clean claims within 45 days to participating and non-participating providers. The insurers have found a loophole with the current interpretation of Act 68 of 1999. HB 564 as amended would close the loophole so that all insurers are complying with the law as intended.

The House Insurance Committee executive director pointed out that Act 68 of 1999 already exists to help non-participating providers receive payment directly and suggested that PDA support amended language to HB 564 that clarifies the issue of direct payment. PDA’s legal counsel agrees with this interpretation. 

Despite claims made by insurance lobbyists, Act 68 has been in existence for 20 years and there has been no decline in network participation. Those insurance companies that already assign benefits to non-participating providers have experienced no decline in network participation. 

HB 564 will drive down health care costs by simplifying the payment and reimbursement process for patients and health care providers. 

HB 564 enhances patient choice and alleviates financial burdens for patients. Some patients cannot see their dentist of choice because some insurance companies do not directly pay the non-participating provider, and the patient cannot afford to pay for services upfront. 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 able to be applied to any provider, regardless of whether or not the provider participates with the insurance plan. 

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.

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.

Dentists are looking to practice in states with a friendly business environment.  Ask any dental student and they will tell you that they factor in a state’s third-party payer practices and policies when deciding where to practice dentistry. Currently, Pennsylvania retains less than 30 percent of its dental school graduates because they are seeking employment in other states with fewer insurance restrictions and fairer reimbursement to cover overhead expenses, salaries, etc. Unfriendly insurance policies are hurting Pennsylvania’s dental workforce capacity.

HB 564 Handout