COVID-19, Dentist

A Normative Letter issued last week requires insurance providers to pay dentists’ “COVID fees” that are charged to patients, which starts at $35 per visit.

The Puerto Rico House of Representatives has approved H.B. 2537 to ban commercial establishments from imposing a “COVID fee” to consumers to offset the investments incurred to reopen their businesses amid the coronavirus pandemic; insurance companies must now cover these costs for dental patients.

As the Senate prepares to evaluate the bill, last week Deputy Insurance Commissioner Rafael Cestero issued Normative Letter CN-2020-279-D, indicating that health insurers must include the coverage code D1999 of the American Dental Association (ADA). Under this measure, dentists are allowed to include the COVID fee—which starts at $35 per visit—but insurers, not patients, must cover this expense.

“The D1999 code must be invoiced by a dentist, under a current contract with an insurer or health services organization, accompanied by the dental procedures performed per day and that are part of the patient’s coverage, after their visit to the dental office. The insurer or health service organization must establish and notify the participating dentists of the corresponding fee, which should not be less than $35.00 dollars per visit to the dental office,” the letter reads.

Dr. David Kerr, president of the Puerto Rico Dental Surgeons Association (CDCPR by its Spanish initials), praised the decision, opining that dentists are the health professionals with the greatest risk of infection. He highlighted the expensive equipment and sanitation tools that this group had to purchase to continue their practices, including hospital surgical grade filters, N95 respirators for the entire staff and antiviral purifiers, among others.

However, he affirmed that patients should not face additional charges and that insurers must assume a “greater responsibility” amid the COVID-19 crisis.

“The money is available. Insurers have been receiving full payment of their business premiums and funds for their Medicaid [Vital] and Medicare [Advantage] programs during these months. However, the use of health services in all areas has been extremely limited or nonexistent and will continue to be so because patients will not attend medical appointments as frequently for fear of contagion.

“The money to cover the D1999 service is in savings and the accumulation of premiums, which they have obtained in these months and the months to come,” Kerr argued, adding that, “Puerto Rico demands greater responsibility from this sector.”

Insurers React

The president of the Insurance Companies Association (Acodese by its Spanish acronym), Iraelia Pernas, said that the entity has held talks with the Insurance Commissioner’s Office to refute the normative letter, arguing that all sectors have incurred coronavirus-related expenses and that dentists may solicit federal aid or loans.

“We believe that it sets a dangerous precedent because if there is a differential for dentists, other sectors may also ask the same thing and the premiums that we charge our beneficiaries do not contemplate that expense,” Pernas told THE WEEKLY JOURNAL.

“Besides, there are federal funds that dentists can ask for to subsidize any additional expenses they have had as a result of the pandemic. It is not a sector that has not been attended to," she added.

Moreover, she noted that the D1999 code, as outlined by the ADA, specifies a fee of $10, which is $25 less than the starting point established by the Puerto Rico government.

“There’s another argument… the fact that a procedure code exists doesn’t imply that an insurer has to cover it. There are procedural codes for all health services and not all services are covered. That said, as the situation elucidates and because there is that rule from the Commissioner’s Office, we will have to follow it for now,” Pernas said.

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