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  WDA Healthy Choices E-Lert  
November 2011 | Legislative E-Newsletter

The Facts:
Non-covered services legislation (AB 251/SB 186)


  • Prohibit insurance companies from setting fees for dental services and procedures they don’t cover.


  • Simplifies Wisconsin patients’ access to dental care: Allows treatment decisions to be between the patient and dentist without interference by a third party that refuses to cover the service.
  • Provides a fairer business climate for Wisconsin’s small-business dental practices: Lets the marketplace determine a reasonable and competitive fee for services outside the scope of a dental benefits plan.

Other facts

  • This bill only affects services NOT covered by an insurance plan. Covered services will continue to be subject to the fee schedule set by the plan.
  • An insurer’s allowed fee for a non-covered service often doesn’t even cover the hard cost of providing that service, which puts a tremendous hardship on small-business dental practices. Without AB 251/SB 186, dentists face two bad options, both of which are poor choices for patients, for dentists and for Wisconsin. These unfortunate options will frustrate patients who want to be engaged in their own health care decisions.

    • Cost-shifting otherwise known as the "hidden tax" - As has occurred in the medical model, dentists would be forced to shift costs to other patients who pay completely out of pocket. This leads to a lack of transparency and to what is often referred to as the "hidden tax" situation.

    • Interruption of patient care - Dentists would be forced to interrupt patient care and hurt their businesses by dropping insurance company contracts.

  • Dentists cannot join together to collectively seek insurance contract changes because of federal antitrust laws. Ironically, insurance companies are one of the few entities exempt from federal antitrust statutes. So, while dentists can't work together to advocate for contract changes, insurance companies receive a favored exemption from these same laws. The government’s involvement in antitrust regulations has essentially created an unlevel playing field that heavily favors the large corporate insurance companies over small-business dental practices.
  • Similar non-covered services laws have passed in 26 states, including Minnesota. That's because it's a good law for patients and local businesses.

Assembly status

  • The Assembly Insurance Committee will hold a hearing on AB 251 at 11 a.m. on Thursday, Nov. 10.
  • AB 251 is sponsored by State Rep. Evan Wynn (R-Whitewater) and these Assembly co-sponsors:

Rep. Chris Danou (D-Trempealeau)
Rep. Mike Endsley (R-Sheboygan)
Rep. Kathy Bernier (R-Chippewa Falls)
Rep. Richard Spanbauer (R-Oshkosh)
Rep. Jeremy Thiesfeldt (R-Fond du Lac)
Rep. Stephen Nass (R-Whitewater)
Rep. Al Ott (R-Forest Junction)
Rep. Jerry Petrowski (R-Marathon)
Rep. Leon Young (D-Milwaukee)
Rep. Lee Nerison (R-Westby)
Rep. Dean Kaufert (R-Neenah)
Rep. Don Pridemore (R-Hartford)
Rep. Steve Doyle (D-Onalaska)
Rep. Joe Knilans (R-Janesville)
Rep. Scott Krug (R-Wisconsin Rapids)
Rep. Warren Petryk (R-Eleva)
Rep. Cory Mason (D-Racine)
Rep. Mike Kuglitsch (R-New Berlin)
Rep. Pat Strachota (R-West Bend)
Rep. Amy Loudenbeck (R-Clinton)
Rep. Joan Ballweg (R-Markesan)
Rep. Keith Ripp (R-Lodi)
Rep. Jeff Stone (R-Greenfield)
Rep. Penny Bernard Schaber (D-Appleton)
Rep. Travis Tranel (R-Cuba City)
Rep. Mary Williams (R-Medford)
Rep. Robin Vos (R-Caledonia)
Rep. Samantha Kerkman (R-Powers Lake)

Senate status

  • SB 186 has been referred to the Senate Health Committee.  State Sen. Leah Vukmir (R-Wauwatosa), the committee chair, has so far declined to hold a public hearing and a vote on the bill.

Sen. Jim Holperin (D-Conover)
Sen. Pam Galloway (R-Wausau)
Sen. Frank Lasee (R-De Pere)
Sen. Kathleen Vinehout (D-Alma)
Sen. Terry Moulton (R-Chippewa Falls)
Sen. Mary Lazich (R-New Berlin)
Sen. Dave Hansen (D-Green Bay)
Sen. Dale Schultz (R-Richland Center)
Sen. Jon Erpenbach (D-Waunakee)


Legislator Q&A:
Why is non-covered services legislation the right move for Wisconsin?

Rep. Robin Vos
State Rep. Robin Vos (R-Burlington)
"Assembly Bill 251 is a common-sense bill. While insurance companies are a necessary part of our health care system and a valuable partner to dentists, I think it is reasonable to say dentists ought to have control over their own business when it comes to price-setting for uncovered services."
Rep. Steve Doyle   State Rep. Steve Doyle (D-Onalaska)
"This legislation will help Wisconsin residents access the dental care they need and keep local businesses strong, and it's clearly in the best interests of our state."
Sen. Van Wanggaard  
State Sen. Van Wanggaard (R-Racine)
"To me, it is an issue of fundamental fairness: When the insurance company isn't making any payment for a service, they shouldn't be establishing a fee for that service. The cost of health care services, including dental, needs to be more transparent. This proposal ensures the market sets fees and not an external third party."
Rep. Cory Mason  
State Rep. Cory Mason (D-Racine)
"I'm glad to be a co-sponsor of this legislation. This bill gets at a basic matter of fairness. If insurance companies want to set the prices, then they have to cover those services. And if insurance companies are genuinely concerned about patient car and cost, then they will reimburse for those needed services. If they're not willing to reimburse, then the cost should be determined between the dentist and the patient."
Rep. Chris Danou  
State Rep. Chris Danou (D-Trempealeau)
"Because I believe that if the insurance company has 'no skin in the game' and isn't actually paying for a service, they shouldn't be setting the price for that service. This bill has a big 'common sense' factor to it and that is why I decided to sign on."


Dentists Statewide Agree:
Why is non-covered services legislation important to your practice and patients?

Dr. Paula Crum, Green Bay periodontist
"Antitrust laws make it impossible for my dental colleagues and me to negotiate fees with the insurance companies. Personally, I have agreed, through my contract with the insurance carrier, to write off a certain amount of my fees for the procedures that they cover. But I find it unfair to have to reduce my fees on services not covered under the dental plan. Many times these fees barely cover the lab costs. In order to overcome these losses, my fees need to increase across my entire fee schedule, which is just transferring higher fees to patients not in these dental plans. This legislation would allow me to make treatment decisions with my patients for those procedures not covered under the insurance plan, and to provide those services at a reasonable fee for all my patients."
Dr. Paula Crum
Dr. Barrett Straub, Port Washington general dentist
"Normally I would oppose government intervention in a contract between two private parties. However, here, the power is weighted so heavily in favor of the large insurance industry that the small, private, business-owning dentist needs government help to even the playing field. While the insurance industry is exempt from federal antitrust legislation, this same law prohibits dentists from collectively bargaining with the insurance companies. As a result, the insurance industry has a say in treatment decisions that should be left to the patient and their dentist."
  Dr. Barrett Straub
Dr. Mary Eileen Geary, Brookfield general dentist
"Dentists set fees based on the time a procedure takes, materials used, personnel involved and our experience and need for continued education. This has helped us keep dental fees far lower than the ever-escalating medical model which involves cost-shifting and has little connection to the actual cost of doing business! It has also helped us to keep experienced and skilled personnel employed and working under a true team concept. If insurance companies are allowed to reach into our private small businesses and set fees for services that are not covered benefits, the fallout will most certainly be cost-shifting. This will result in eventual layoffs, escalating prices and diminished access to care."
  Dr. Mary Eileen Geary



This "Healthy Choices" E-lert focuses solely on an important bill - AB 251/SB 186 - that would prohibit dental insurers from setting price caps on procedures and services they don't even cover. This unfair practice hurts patients and small-business dental practices and goes against the concept of a free-market economy.

We strongly urge Wisconsin to follow the lead of 26 other states that have already passed laws outlawing the practice and address this important legislation as soon as possible.

Mara Brooks   Mara Brooks, WDA Government Services Director
608-250-3442 or mbrooks@wda.org
Across the Country

Non-covered services legislation has passed in 26 states on margins of 10:1.

Alaska (2010)
Arizona (2010)
Arkansas (2011)
California (2010)
Connecticut (2011)
Georgia (2011)
Idaho (2010)
Iowa (2010)
Kansas (2010)
Louisiana (2010)
Maryland (2011)
Minnesota (2011)
North Carolina (2010)
New Mexico (2011)
Mississippi (2010)
Nebraska (2010)
North Dakota (2011)
Oklahoma (2010)
Oregon (2010)
Rhode Island (2009)
South Dakota (2010)
Tennessee (2011)
Texas (2011)
Virginia (2010)
Washington (2010)
Wyoming (2011)

WDA Leaders

Gene Shoemaker, DDS

Steve Stoll, DDS

Vice President
Tim Durtsche, DDS
La Crosse

Immediate Past-President
Kent Vandehaar, DDS
Chippewa Falls

Legislative Committee Chair
Eric teDuits, DDS

Wisconsin Dental Political Action Committee Chair
Dave Clemens, DDS
Wisconsin Dells

Executive Director
Mark Paget

Director of Government Services
Mara Brooks

Contract Lobbyist
Peter Christianson
DeWitt Ross & Stevens, S.C.

Contract Lobbyist
Forbes McIntosh
Government Policy Solutions

About the WDA

The WDA, established in 1870, is the dental profession's leading voice in Wisconsin. It has 3,000 member dentists, representing 85 percent of all licensed, practicing dentists in the state.

The WDA pursues a variety of activities and programs relating to advocacy, education, empowerment and service. All programs support the WDA's mission to promote professional excellence and quality oral health care in Wisconsin.


Executive Office: 6737 W. Washington St., Suite 2360, West Allis, WI 53214 | 414-276-4520
Legislative Office: 10 East Doty, Suite 509, Madison, WI 53703 | 608-250-3442
Copyright © 2011 All Rights Reserved.

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