State Update

Iowa Supreme Court Rejects Dental Fee Capping

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On May 17, the Supreme Court of Iowa ruled in favor of the Iowa Dental Association in the case of Iowa Dental Association v. Iowa Insurance Division and Iowa Insurance Commissioner, reversing the decision of the Iowa District Court for Polk County.

The Supreme Court of Iowa was asked to decide whether to uphold the Iowa Insurance Commissioner’s interpretation of a law governing dental insurance plans. H.F. 2229, passed by the Iowa Legislature in 2010, provides in part that a contract between a dental plan and a dentist for the provision of services to covered individuals under the plan shall not require that a dentist provide services to those covered individuals at a fee set by the dental plan, unless such services are covered under the dental plan. 

Under the Iowa Insurance Commissioner’s interpretation of the law, an insurer may limit the maximum fees charged by dentists for services that are generally included in the insurer’s dental plan, even though they are not actually reimbursed by the insurer because of a plan restriction.  

The Supreme Court of Iowa concluded that the services in question do not meet the statutory definition of “covered services” because they have not been “reimbursed under the dental plan.” Accordingly, the fee for them may not be “set by the dental plan.”

During the 2012 and 2013 legislative sessions, more than ten states introduced legislation regarding non-covered dental services.