The ADA believes that requirements related to advanced explanation of benefits should be applicable to dental plans as they work in concert with good faith estimates for the benefit of both patients and providers.
That was one of the key takeaways from the ADA’s response to the Centers for Medicare & Medicaid Services request for information on the advanced explanation of benefits and good faith estimate requirements of the No Surprises Act. The No Surprises Act, also known as surprise billing, is a new law designed to give consumers more billing protection. The ADA’s comments emphasized the unique challenges dental offices face when implementing these requirements.
In the Nov. 14 response, ADA President George R. Shepley, D.D.S., and Executive Director Raymond A. Cohlmia, D.D.S., also asked CMS to consider the following:
The role of dental plans
In answering what approaches CMS should consider before applying requirements, the ADA said it “strongly believes and encourages” that requirements related to advanced explanation of benefits be applicable to dental plans as they work together with good faith estimates for the benefit of the individual and provider.
To illustrate this, the ADA said if an individual with a dental benefit comes to a dentist, the dentist does not know what, if any, of that patient’s covered benefit has already been utilized, but even if basic assumptions can be utilized to provide a very rough good faith estimate, it’s not possible to be accurate within $400 if the dental plan ends up denying coverage after the fact. The patient will also often not know the details of their plans or the benefits that they have already used for that year. The advanced explanation of benefits is necessary for dental plans to provide to the patient and must go together with the provider good faith estimate.
Source: ADA responds to No Surprises Act request for information / ADA