State department rules against insurance firms regarding COVID-19 surcharges
Insurance companies can’t allow dentists in their network to charge members PPE fees and must get previously paid surcharges reimbursed, state regulators in New York said.
The State Department of Financial Services, which regulates insurance firms, published guidelines last week directing medical, dental and vision insurers to combat surcharges.
Insurance firms must notify in-network providers that patients cannot be responsible for PPE fees — temporary charges that tend to be no more than $25 and are meant to recoup a portion of providers’ personal protective equipment expenses. Insurers need to direct providers to refund previously paid PPE fees. They must also submit a report on reimbursement efforts to the state within 90 days, the DFS memo said.
Dental practices are spending at least $20 outfitting each staff member with PPE per patient visit, Nassau County Dental Society Executive Director Dr. Eugene Porcelli said.
DFS’ memo does not address the underlying issue or provide meaningful assistance to dentists, said Dr. Mark Feldman, executive director of the New York State Dental Association.
“NYSDA is concerned that insurance providers are not willing to reimburse additional personal protection equipment (PPE) costs during this crisis,” Feldman said in a statement. “This is why we are launching initiatives, on behalf of our members, to address the burdensome cost of dental PPE.”
Feldman said that surcharges may still be permissible under some insurance policies and when patients are not insured.
DFS does not approve policy provisions that hold patients responsible for the cost of PPE, the department said. The guidance instructs insurers and health care providers to collaborate on absorbing increased costs.
“Consumers are not liable for fees that go beyond their financial responsibility in the insurance policies or contracts,” Superintendent of Financial Services Linda Lacewell said in a statement. “It is essential that health care providers and insurers collaborate so that consumers receive the care they need during this uncertain time, without extra fees.”
Patient advocacy groups said they have mostly fielded complaints about surcharges at dental offices.