Wisconsin Assembly Approves Limits on Price Setting by Dental Insurers

Image courtesy of Stuart Miles / FreeDigitalPhotos.net

Image courtesy of Stuart Miles / FreeDigitalPhotos.net

On Wednesday, April 17, 2013, the Wisconsin Assembly, by a vote of 89 to 8, passed a bill that prohibits insurers who provide limited-scope dental benefit policies from setting fees for dental and related services not covered by those policies. Similar laws, commonly known as “non-covered services legislation” have already been passed in 29 other states, including Minnesota, which passed similar legislation in 2011, and Illinois, where non-covered services legislation went into effect on January 1st of this year.

The bill passed by the Wisconsin Assembly prohibits dental insurers from setting fees for non-covered services and also prohibits insurers from providing nominal or de minimis coverage for a dental or related service solely for the purpose of avoiding the new fee-setting prohibition.  In addition, the bill prohibits dentists from charging an insured patient more than the dentist’s usual, non-discounted fee for a non-covered service.

The Wisconsin Dental Association supported passage of the bill, while opponents included The Wisconsin Insurance Alliance, Wisconsin Manufacturers and Commerce and The Alliance (a not-for-profit cooperative of employers focusing on health care issues).

The Wisconsin Senate must now consider the proposed legislation.  If passed by the Senate and signed by the Governor, the new law would take effect on January 1, 2014.

This article was written by Janice L. Gauthier, Esq. Ms. Gauthier has an A.B. from Harvard University and a J.D. from Harvard Law School. She is the owner of The Gauthier Law Group, LLC, a boutique law firm that represents dentists, physicians, health care providers, professional service practices and other businesses and business owners in Wisconsin and Illinois. You can contact Ms. Gauthier at 414-270-3857 or by email. To learn more about Ms. Gauthier’s background and experience, visit her Google or LinkedIn profiles.

© 2013 The Gauthier Law Group, LLC