Insurance companies can't allow dentists in their network to charge members PPE fees and must get previously paid surcharges reimbursed, state regulators said.
The State Department of Financial Services, which regulates insurance firms, published guidelines on Wednesday 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.
"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.
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 previously told Newsday.
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, of Roslyn, 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 without impacting consumers.
Aetna considers PPE part of the cost of underlying procedures and doesn't generally reimburse dentists and doctors for the gear, the insurance company said in a statement. Cigna is working with providers to ensure that those costs aren't passed on to customers, the insurer said in a statement.
In June, Delta Dental began temporarily giving providers additional funding to assist with the increased costs of operating during a pandemic, such as PPE, according to representative Kurt Schroeder.
"Billing Delta Dental patients for PPE expenses and other surcharges is not contractually allowed," Schroeder said in a statement.
DFS' guidance will not protect uninsured patients, but sends a strong message that surcharges are not welcome, said Elisabeth Benjamin, vice president for health initiatives at Community Service Society. The nonprofit's Community Health Advocates team runs a hotline that helps New Yorkers access health care and sort through billing concerns.
“We’ve gotten a bunch of complaints from people going to their dentist and suddenly getting this extra charge," Benjamin said. "It really adds up."
Patients who are charged for PPE can notify insurers, which are obligated to provide members with contact information where complaints will be handled, according to Claire Rosenzweig, president of the Better Business Bureau of Metropolitan New York.
Long Islanders can file complaints about insurance policies with DFS at 518-474-6600 or at dfs.ny.gov/complaint. Consumers can get billing assistance from Community Health Advocates at 888-614-5400.