WASHINGTON DC (July 16, 2019) — Representatives Dave Loebsack and Earl L “Buddy” Carter today introduced the Dental and Optometric Care Access (DOC Access) Act to ensure patients have access to high-quality dental and optometric care by providing fairness in contracts between doctors and dental and vision insurers. This bipartisan legislation allows for dentists, optometrists, and ophthalmologists to charge an amount that is usual and customary for the services that are not covered under an insurance plan rather than the insurer’s mandated fee schedule. Reps Loebsack and Carter both serve on the Committee on Energy and Commerce.
“It is imperative that dentists, optometrists, and ophthalmologists are able to provide their patients with high-quality care,” said Rep Loebsack. “The DOC Access Act will give dentists, optometrists, and ophthalmologists the freedom to charge a reasonable rate for the care their patient need. I am pleased to work with Rep Carter to introduce this legislation that will remove anti-competitive practices from our nation’s healthcare system.”
“By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need,” said Rep Carter. “This legislation is a strong and necessary step in bringing free-market principles back into health-care by removing anti-competitive business practices. I’m very glad to introduce this bill again this Congress with my friend, Rep Loebsack, to ensure doctors are able to meet patient needs.”
Thirty-nine states have passed laws addressing the coverage and fees for non-covered services. However, many insurance providers are able to sidestep these laws because the offered plans are regulated on the federal level instead of on the state level. This proposal would not preempt state law.
Background
For years, insurance providers have mandated through agreements that doctors must charge patients for services and materials that are not covered under vision or dental plans regardless of the usual and customary rate. Many times, these mandated charges, which are set by the insurance provider’s fee schedule, do not cover the full cost of the service or operation. This ultimately leads to dentists and optometrist providing services at a loss to their practice.
Overall, this legislation will bring better practices and free market principles back into the healthcare system and provide fairness to agreements between doctors and insurance providers by protecting doctors from anti-competitive business practices.
