New York Looks for PPE Fee Refunds from Dental Providers

Dentistry Today
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The New York State Department of Financial Services (DFS) has issued guidance to dental insurers that their participating providers should not be charging separate fees for personal protective equipment (PPE) costs and that the insurers should seek refunds from those participating providers on behalf of their insureds.

“In these uncertain times, as many New Yorkers are struggling to make ends meet, healthcare providers should not be creating additional financial burdens on their patients,” said Governor Andrew Cuomo. “This action will ensure that New Yorkers are protected against excessive fees associated with the necessary and at times lifesaving care they need.”

The DFS said it has received consumer complaints that participating healthcare providers, particularly dental providers, are improperly charging patients fees for PPE or other charges related to increased costs due to COVID-19. These fees are then being passed to their insurers and go beyond the insured patient’s applicable cost-sharing, the DFS said.

Participating providers should not charge a patient fees or other charges in addition to their financial responsibility for covered services, and insurers should not cover these charges, the DFS said. Also, the DFS does not approve of policy or contract provisions that hold insured patients responsible for the cost of a participating provider’s PPE.

“DFS’s circular letter reminds insurers in New York State that they should ensure that consumers are not charged PPE fees. Consumers are not liable for fees that go beyond their financial responsibility in the insurance policies or contracts. It is essential that healthcare providers and insurers collaborate so that consumers receive the care they need during this uncertain time, without extra fees,” said superintendent of financial services Linda A. Lacewell.

“Healthcare providers should not be charging patients for PPE under any circumstances. Providers have an obligation to ensure the safety of their patients and employees during all medical visits, from routine checkups to surgical procedures,” said New York State health commissioner Dr. Howard Zucker.

The DFS advises insurers to:

  • Immediately notify their participating providers not to charge PPE fees and that insureds should be held harmless for these charges
  • Instruct providers to refund PPE fees to insureds
  • Notify insureds that they should not be charged for PPE fees and provider insureds with insurers’ contact information to submit related complaints
  • Work with their providers to resolve issues relating to increased costs due to COVID-19, including PPE fees, so insureds are held harmless for these fees, which may require that insurers request information from providers about whether insureds were charged improper fees
  • Work with their providers to ensure that refunds are provided to insureds
  • Within 90 days of the circular letter, effective August 5, report to DFS the amount of PPE fees charged to insureds, the number of insureds impacted, and a description of how refunds will be provided

According to the New York State Dental Association (NYSDA), the DFS guidance is carefully crafted to apply only to participating providers with a particular insurance plan. It has no applicability to non-participating providers. It also is not directed to healthcare providers but to insurers, because DFS has no jurisdiction over healthcare providers.

However, the NYSDA expects a collateral effect for dentists who are participating providers with an insurance plan, which will seek to recover money charged to its insureds separately for PPE.

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