U.S. Rep. Buddy Carter (R-GA) recently proposed a bipartisan bill that aims to provide fairness in contracts between healthcare providers and vision and dental insurers by allowing dentists and optometrists to charge a fair amount for the services that are not covered under an insurance plan rather than the insurer’s mandated fee schedule.
“Let’s be frank — health care is unreasonably expensive and bogged down by confusing red tape,” Rep. Carter said. “By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need.”
The congressman on March 7 sponsored the Dental and Optometric Care Access (DOC Access) Act of 2023, H.R. 1385, with two original cosponsors, including U.S. Rep. Yvette Clarke (D-NY).
According to the text of the bill, under a group health plan or individual or group health insurance coverage, including those offering limited scope dental or vision benefits, the plan or coverage must allow a doctor of optometry, doctor of dental surgery, or doctor of dental medicine that participates in the plan or coverage and provides services that are not covered under the plan, to charge the enrollee any amount determined by the doctor that is equal to, or less than, the usual and customary amount that the doctor charges individuals who are not enrolled for such services.
“Unfortunately, special legal treatment for and a lack of competition among vision plans has led to higher prices and less access to care for patients while doctors face the difficult choice of providing needed care to folks in their community or keeping their practices viable,” said Rep. Clarke. “The DOC Access Act aims to combat this issue by putting the power back in the hands of the patients and their doctors to control their own important healthcare decisions.”
If enacted, the bill also would prohibit a plan or coverage from directly or indirectly restricting or limiting a doctor’s choice of laboratories or choice of source and suppliers of services or materials provided by the doctor to an enrolled individual, says the bill’s text.
H.R. 1385 has been endorsed by the American Optometric Association and the American Dental Association and is under consideration by the U.S. House Energy and Commerce Committee.
“The DOC Access Act is a strong and necessary step in bringing free market principles back into health care and putting patients before profits,” said Rep. Carter.