Legislature(2009 - 2010)CAPITOL 106

02/23/2010 03:00 PM House HEALTH & SOCIAL SERVICES

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= bill was previously heard/scheduled
Heard & Held
Heard & Held
Heard & Held
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                  HB 309-DENTAL CARE INSURANCE                                                                              
CO-CHAIR KELLER announced  that the next order  of business would                                                               
be HOUSE BILL  NO. 309, "An Act prohibiting  health care insurers                                                               
that provide dental care coverage  from setting a minimum age for                                                               
receiving dental care coverage, allowing  those insurers to set a                                                               
maximum age  for receiving dental  care coverage as  a dependent,                                                               
and prohibiting those  insurers from setting fees  that a dentist                                                               
may charge  for dental services  not covered under  the insurer's                                                               
4:25:59 PM                                                                                                                    
CECILE  ELLIOTT, Staff  for  Representative  Bill Thomas,  Alaska                                                               
State Legislature, testified  that the first provision  of HB 309                                                               
"prohibits insurance companies  from establishing age limitations                                                               
on  young   children  receiving  dental  care   services."    She                                                               
explained that  there was  a current  national trend  for minimum                                                               
age requirements,  limiting dental care  coverage to 4  years and                                                               
MS.  ELLIOTT  stated   that  the  second  provision   of  HB  309                                                               
prohibited  insurance  companies  from  fee  capping  non-covered                                                               
services, which  she explained  to be  the practice  by insurance                                                               
companies for  dictating the  cost of  dental services  that were                                                               
not covered by insurance.                                                                                                       
4:27:04 PM                                                                                                                    
CO-CHAIR  HERRON  asked  for  an  explanation  of  the  contracts                                                               
between  dentists and  health  insurers, and  he  noted that  the                                                               
constitution  prohibited   the  passage  of  any   law  impairing                                                               
obligation of contracts.                                                                                                        
4:27:29 PM                                                                                                                    
MS. ELLIOTT replied that she would need to research this.                                                                       
4:27:36 PM                                                                                                                    
CO-CHAIR HERRON  asked about the  effect of the bill  on Alaskans                                                               
who exceeded the cap on dental insurance coverage.                                                                              
4:28:01 PM                                                                                                                    
MS. ELLIOTT replied that HB 309  would allow the dentist to offer                                                               
any  additional  service  for   a  reasonable  fee,  without  the                                                               
insurance  company dictating  that  fee.   She  pointed out  that                                                               
dentists already had published fee schedules.                                                                                   
4:29:12 PM                                                                                                                    
MS. ELLIOTT,  in response to  Representative Wilson,  agreed that                                                               
the  contracts  for managed  care  "were  entered into  with  the                                                               
dentists'  knowing,"  but that  the  additional  clause for  non-                                                               
covered service was problematic.                                                                                                
4:29:52 PM                                                                                                                    
REPRESENTATIVE  T. WILSON  asked  to clarify  that  HB 309  would                                                               
limit "what they could put in a contractual agreement."                                                                         
4:30:20 PM                                                                                                                    
MS.  ELLIOTT  agreed that  dentists  entered  into a  contractual                                                               
agreement  for  covered  services,  but  that  there  was  a  fee                                                               
schedule for non-covered services, as well.                                                                                     
REPRESENTATIVE  T. WILSON  pointed out  that this  was regulating                                                               
4:30:50 PM                                                                                                                    
CO-CHAIR KELLER opined that it was  hard to analyze the real cost                                                               
resulting from insurance regulation.                                                                                            
4:32:03 PM                                                                                                                    
SHEILA  TALLMAN  stated  that   Premera  had  concerns  with  the                                                               
provision  limiting  the  fees for  non-covered  services.    She                                                               
opined that  HB 309 would increase  the cost to consumers,  as it                                                               
would not allow  dentists to consistently pass  on the discounted                                                               
rates  for non-covered  services  which  insurers did  negotiate.                                                               
She expressed concern  that a Premera policy holder  may not know                                                               
to ask  for, and receive,  a discount.   She pointed to  the bill                                                               
language,  which  stated  that,   should  a  benefit  maximum  be                                                               
reached, a patient would be billed, sometimes at a higher rate.                                                                 
4:33:30 PM                                                                                                                    
CO-CHAIR KELLER asked about similar bills in other states.                                                                      
MS. TALLMAN  replied that new  bills were being offered  in other                                                               
states, including  Oregon and  Washington.   She shared  that she                                                               
had not seen any cost impacts.                                                                                                  
4:34:21 PM                                                                                                                    
CO-CHAIR KELLER asked for a reason to the legislation.                                                                          
MS.  TALLMAN offered  her belief  that  some insurance  providers                                                               
were not providing options for the  dentists, but that this was a                                                               
negotiated  provision  between  the dentists  and  the  insurance                                                               
4:35:18 PM                                                                                                                    
REPRESENTATIVE T. WILSON  asked if HB 309  would affect insurance                                                               
MS.  TALLMAN  replied  that  the  main impact  would  be  on  the                                                               
consumers  for out  of pocket  costs.   She added  that insurance                                                               
premium  rates  could  be  affected  as  consumers  visited  non-                                                               
participating  dentists, which  would  bring  lower revenues  for                                                               
participating dentists.                                                                                                         
MS.  TALLMAN, in  response to  Representative  T. Wilson,  stated                                                               
that dental providers  were free to negotiate  the contracts, but                                                               
that consumers  were directed  to participating  dentists through                                                               
the contract, which was a benefit to the dentist.                                                                               
4:36:49 PM                                                                                                                    
REPRESENTATIVE SEATON  asked if a  dentist could charge  a higher                                                               
amount  for the  same  service when  it was  in  addition to  the                                                               
covered service.                                                                                                                
4:37:54 PM                                                                                                                    
MS. ELLIOTT replied  that the dentist had a  posted fee schedule,                                                               
which was  available to the consumer.   She agreed that,  as fees                                                               
were discounted  with the insurer, the  non-covered service could                                                               
be more expensive.   She highlighted that  the non-covered clause                                                               
of the managed care contract was not negotiable.                                                                                
4:39:23 PM                                                                                                                    
REPRESENTATIVE SEATON asked to clarify the notice of coverage.                                                                  
4:40:47 PM                                                                                                                    
MS. ELLIOTT said that Dr. Mark Prator could better answer this.                                                                 
4:42:05 PM                                                                                                                    
JOHN WOLLER,  Dentist, Alaska Dental  Society, explained  that HB
309 was  attempting to  level the  playing field  for non-covered                                                               
services.  He  said that dentists were not allowed  to enter into                                                               
collective  bargaining agreements  with insurance  companies, but                                                               
that it was possible to seek  legislative action.  In response to                                                               
Representative  T. Wilson,  he clarified  that dentists  were not                                                               
allowed to  negotiate with  insurers.  He  expressed a  desire to                                                               
limit the  impact an insurance  company could have for  pricing a                                                               
service which they did not cover.   He pointed out that, although                                                               
the  insurance  company  stated  a   desire  to  limit  fees  for                                                               
consumers,  it  was the  dental  provider  who absorbed  all  the                                                               
costs.  He  clarified that the contracts were  a small percentage                                                               
of dental care in  Alaska.  He stated that the  reason to sign on                                                               
to the insurance provider fee  schedule was to get more patients.                                                               
He declared that most dental  practices were small businesses and                                                               
they needed  to remain profitable.   He reported  that contracted                                                               
fee schedules  were at cost,  and did  not offer any  profit; the                                                               
profit  was   from  non-covered  services  at   the  regular  fee                                                               
schedule.   He  said  the  contracts had  language  to limit  the                                                               
regular fee  schedule.  He  asked that  the committee pass  a law                                                               
for  insurance companies  to help  defray the  cost, as  the cost                                                               
should not all be the responsibility of the dentist.                                                                            
4:46:51 PM                                                                                                                    
REPRESENTATIVE T. WILSON asked to  clarify that the contract with                                                               
the insurance company was only for covered care.                                                                                
DR. WOLLER  said that  HB 309  would prevent  insurance companies                                                               
from setting the fee for all non-covered services.                                                                              
4:48:16 PM                                                                                                                    
REPRESENTATIVE  T.  WILSON asked  to  clarify  how the  insurance                                                               
company could dictate this.                                                                                                     
4:48:38 PM                                                                                                                    
DR. WOLLER agreed that was what HB 309 was all about.                                                                           
DR. WOLLER,  in response to  Representative T. Wilson,  said that                                                               
the insurance companies would threaten  to withdraw the contracts                                                               
if the agreement for fee  setting to all non-covered services was                                                               
not included.  He offered an  example of a hotel contracting with                                                               
a tour  company for  discounted rooms, and  then having  the tour                                                               
company state  that the hotel  needed to also discount  its food,                                                               
gifts, and tours.   He said that the costs  would just be shifted                                                               
to other patients without insurance.                                                                                            
4:51:52 PM                                                                                                                    
REPRESENTATIVE  SEATON asked  if the  insurance company  was only                                                               
trying to  limit the  fee for non-covered  service to  the policy                                                               
holders of the insurance.                                                                                                       
DR. WOLLER agreed.                                                                                                              
4:52:38 PM                                                                                                                    
MARK  PRATOR, Dentist,  Alaska Dental  Society, noted  that there                                                               
was speculation  as to who was  going to benefit, and  he pointed                                                               
to  the concern  for  non-covered  services.   He  opined that  a                                                               
greater problem  was for access  to care, as  insurance companies                                                               
were attempting to  limit patients according to age.   He pointed                                                               
out  that, as  rural  dentists dropped  out  of these  contracts,                                                               
there would not be any care  for rural residents.  He stated that                                                               
allowing insurance companies  "to dictate what we  can charge for                                                               
services that are  not even a part of their  plan" would create a                                                               
lot of problems.                                                                                                                
4:55:32 PM                                                                                                                    
CO-CHAIR KELLER closed public testimony.                                                                                        
[HB 309 was held over.]                                                                                                         

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