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 policy." 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 older. 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 contracts. 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 providers. 4:35:18 PM REPRESENTATIVE T. WILSON asked if HB 309 would affect insurance rates. 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.]