Behind the fee schedule
If an insurance plan won’t pay for a service, why does it still get a say in what your practice charges?
It’s a fair question. It’s also the kind that turns a straightforward billing conversation into a reading assignment.
The Dental and Optometric Care Access Act of 2025, also called the DOC Access Act, addresses fees for noncovered services and other dental and vision plan contract terms. Here’s what the proposal actually says, and what deserves a closer look before anyone changes a fee.
01 · Noncovered services
More control over fees, with limits.
Under the introduced version of H.R. 1521, participating dentists and optometrists could set charges for services that are not covered, up to the usual and customary amount they charge people who are not enrolled in that plan.
That distinction matters. The proposal does not simply say, “Charge whatever you like whenever insurance pays nothing.” The reason a service is unpaid still matters.
“Unpaid” and “noncovered” are not interchangeable.
The bill’s definition of covered services includes services that would be reimbursable except for certain contract limits, such as deductibles, waiting periods, frequency limits, and alternative benefit payments. It also addresses whether a plan’s payment obligation is reasonable rather than merely nominal.
There is a specific dental-cleaning exception: the introduced text would retain the contracted network fee for cleanings, including cleanings beyond the plan’s annual maximum.
The practical point: read the actual provision and the applicable plan terms. A zero on an explanation of benefits is a starting point for review, not a complete answer about what a patient owes.
02 · The rest of the contract
There’s more here than a fee schedule.
The proposal also addresses two other contract questions that can affect a practice’s choices:
Longer contract extensions.
For limited-scope dental and vision plan agreements, an extension for a term longer than two years would require the provider’s prior acceptance of that extension.
Choice of labs and suppliers.
The bill would prohibit a plan from directly or indirectly restricting the provider’s choice of laboratory, source, or supplier for relevant services and materials.
The text also includes a provider election to opt out of the fee and laboratory-choice provisions for a specified plan year, and language addressing conflicting state laws. Those details are another reason to avoid treating the headline as the whole rule.
03 · Back at the practice
You don’t have to wait to get organized.
A bill can stay in the headlines for a while. Your next patient conversation is probably happening much sooner.
Know the agreement.
Make the conversation clearer.
Keep the current contract within reach.
Save the agreement, amendments, fee schedule, and relevant payer guidance in one place. Confirm which version applies before updating your billing workflow.
Find out why the plan didn’t pay.
Separate a coverage exclusion from a deductible, frequency limit, missing documentation, or processing issue. Check the explanation of benefits against the plan and contract.
Check before changing patient charges.
Confirm the applicable state rules and contract requirements with qualified guidance. A news headline should not be the final approver of your fee schedule.
Give the patient a clear explanation.
Explain what the estimate includes, what remains uncertain, and how the office will follow up. Keep the conversation understandable without promising a payment outcome.
Less guessing. Better conversations.
Keeping up with dental insurance legislation is useful. Knowing which rules apply to the claim in front of you is what helps your team today.
At Paragon, we can help you take a closer look at your insurance billing workflow and the follow-up it needs. If your team needs support connecting the paperwork to the next practical step, let’s talk.
Read the sources.
- Congress.gov: H.R. 1521, bill tracker and legislative record
- U.S. Government Publishing Office: the introduced DOC Access Act of 2025 text
- U.S. House: September 15, 2026 hearing record, including H.R. 1521
Originally published June 2, 2025. Revised and sources reviewed October 18, 2026. General educational information, not legal advice. Contract and state requirements vary.