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Dentists say insurers put the bite on them

Dentists say they are getting squeezed. Insurance companies say they are helping hold down costs for patients.

But a dispute about discounted rates for some dental care has turned into a legislative fight between the Florida Dental Association and major players in the health-insurance industry.

The dispute centers on patients who hit the coverage limits of their dental-insurance policies but need additional care. Dentists contend that insurers are effectively forcing them to charge discounted rates for the additional care, even though patients --- and not the insurers --- are picking up the tab.

A House subcommittee Tuesday approved a bill that would bar insurance contracts from requiring dentists to charge fees set by insurers for such "non-covered" services. A Senate committee last week approved a similar measure.

"If you're not covering it, you shouldn't get to call the price,'' said Rep. Ed Hooper, a Clearwater Republican who is sponsoring the House measure.

But the health-insurance industry, including companies such as Blue Cross and Blue Shield of Florida and Humana, argue the proposal would lead to increased dental costs or cause patients to forego needed care.

"Will this improve access to dental care?" asked Michael Garner, president of the Florida Association of Health Plans. "I would argue it does not.''

As an example, Humana lobbyist Harry Spring said his company has about 60,000 low-cost policies that cover only basic services such as teeth cleanings, X-rays and fillings. He said an advantage of the policies is that customers get discounts on other procedures --- care that patients might not get if they have to pay higher prices.

"The reason they bought such a low-cost plan is because that's all they can afford,'' Spring told the House Health & Human Services Quality Subcommittee.

Contracts between insurers and dentists typically include discounted rates for services covered by the policies. It is something of a trade-off for dentists: In exchange for agreeing to charge lower rates, they can attract patients who are customers of the insurance plans.

But the legislative dispute involves contract provisions that extend such discounts to services that are not covered by the insurers. Garner said the additional services could be as simple as patients needing more cleanings each year than are covered by their policies.

Larry Nissen, president of the Florida Dental Association, said dentists are presented with a "take it or leave it" choice in signing contracts that include the provisions. He said dentists often can't afford to give up the contracts because that could lead to losing large numbers of patients.

But critics of the bills object to lawmakers getting involved in the middle of the dispute.

"I'm very bothered by the government getting into the contract business,'' said Sen. Steve Oelrich, a Cross Creek Republican who voted against the proposal last week in the Senate Banking and Insurance Committee.

But Senate sponsor Alan Hays, R-Umatilla, said fees should be determined by dentists and patients when services are not covered by insurance plans.

"We're saying to the companies, if your plan does not cover a particular service provided by this doctor, then you have no business interfering with that doctor-patient relationship,'' said Hays, who is a dentist.

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail at jim.saunders@healthnewsflorida.org.