Dentists, optometrists win right to charge patients full price
H.R. 1521 — DOC Access Act of 2025 · Filed by Buddy Carter (R-GA) · 119 cosponsors · Introduced Feb 24, 2025 · Referred to committee
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What it does
This bill amends federal health insurance law to allow dentists and optometrists who participate in insurance networks to charge patients for uncovered services at their usual rates (what they charge uninsured patients), rather than at negotiated network rates. It also prevents insurers from restricting which labs dentists use, allows limited-scope dental/vision plans to extend beyond 2 years only with provider consent, and requires states to enforce these rules or face federal enforcement. Dentists and optometrists benefit by charging higher out-of-pocket rates; patients may face higher costs for services outside their plan's coverage.
Why we flagged it
The bill's core function is to remove insurer-negotiated rate caps for out-of-network dental and vision services, allowing providers to charge patients their full usual-and-customary rates. It is framed as 'access' but mechanically deregulates pricing in a way that benefits providers at patient expense.
What the text implies
- Patients with limited-scope dental/vision plans (often lower-cost plans) may see those plans become less attractive as providers opt out or demand higher out-of-pocket payments, potentially reducing access for cost-conscious enrollees.
- The bill's 'usual and customary' standard is undefined and provider-determined, creating potential for price inflation without transparency or benchmarking.
The full analysis lists 4 implications of this text.
Who stands to gain
dentists and dental practices; optometrists and vision practices; dental and vision service suppliers