September 7, 2000

Dear Senator:

We write on behalf of the 144,000 members of the American Dental Association to urge you to ensure that the final Patients’ Bill of Rights includes freestanding dental plans. Not surprisingly, some dental plans oppose the notion of a law requiring them to be accountable for decisions to delay, deny or limit patient care, just as many medical plans have worked tirelessly to thwart patient protection legislation. We believe that the rationale for including dental plans is clear, and we categorically refute the dental plans’ primary arguments in opposition: that their abuses are too few to warrant curbing; that dental claim denials usually occur after patients have received treatment; that the proposed reforms would be too costly; and that the costs of dental care are too insignificant to merit attention.

Managed dental care plans cover far fewer Americans than do managed care medical plans. This accounts for the fact that consumer complaints regarding dental plans are fewer than those regarding medical plans. Nevertheless, problems exist among these dental plans, and Congress can take a cue from the dental profession—which has so successfully practiced disease prevention—by including dentistry in the Patients' Bill of Rights now, rather than waiting for those problems to worsen.

The fact that a majority of dental claim denials occur after treatment seems a flimsy argument for not providing patients with a method of contesting those denials. Both the Senate- and House-passed versions of the Patients’ Bill of Rights explicitly cover these retrospective denials, although only the House bill does so for dental plans. Dental patients deserve the same recourse as medical patients when a plan improperly denies a claim, regardless of whether the denial occurs before or after the patient receives treatment. A dental claim amounting to a few hundred dollars may seem insignificant when compared to the huge price tags of some medical claims. But a few hundred dollars can seem quite significant to millions of American families who struggle to live from paycheck to paycheck.

We also believe that the dental plans grossly exaggerate the costs associated with providing a few basic patient protections, a tactic already worn thin from overuse by the HMOs. Dental plans could contract on an as-needed basis with independent external review entities to adjudicate claim disputes, most of which could be addressed through the internal review process outlined in the Patients’ Bill of Rights. The legislation would simply ensure that every health plan—medical or dental—provides a timely, thorough and fair appeals process. Numerous studies, including those by the Congressional Budget Office, estimate that a comprehensive Patients' Bill of Rights would increase overall health costs only nominally. Although even a small cost increase should not be incurred lightly, Americans have said in poll after poll that they would willingly pay higher premiums for the assurance of a few basic patients' rights.

The Patients’ Bill of Rights would eliminate the confusing patchwork of state rules, providing medical patients with the same baseline of protections against managed care abuses, regardless of where they live. Dental patients should receive no less. Whether the issue is appeals of claim denials, the right to choose a doctor, access to specialists or many of the other provisions in the Patients’ Bill of Rights, your constituents should receive the same protections whether they are medical or dental patients. This continuity will greatly reduce people's confusion over their rights and responsibilities in both their medical and dental coverage, making them more efficient consumers of health care.

We hope that you will work to ensure that dental plans are included in any patient protection bill that you vote on this year. Please direct any questions to Ms. Dorothy J. Moss, director of the ADA Washington Office, at (202) 898-2400.

Sincerely,

Richard F. Mascola, D.D.S. 
President 

John S. Zapp, D.D.S.
Executive Director

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