Why the Dental and Optometric Care Access Act Matters to Your Practice in 2025
- Shasta Clark
- Jun 2
- 2 min read
If you’ve ever been frustrated by insurance companies telling you what to charge, even for services they don’t cover, you’re not alone. A new piece of legislation reintroduced in early 2025 could change that.
The Dental and Optometric Care Access Act, now back in front of Congress, targets two long-standing issues that directly affect the way dental providers operate and get paid. Here’s what you should know, and why it matters.
✅ Stops Insurers from Capping Fees on Non-Covered Services
Many dental plans currently limit what you can charge patients for services the plan itself doesn’t reimburse. That means insurers are influencing your cash-pay pricing, without putting a dime toward the service.
If passed, this bill would make it illegal for insurers to set fees on non-covered services, putting pricing power back in your hands.
✅ Encourages Fairer Competition Among Insurers
The bill also takes aim at the growing concentration of power among just a few national dental carriers. By preventing anti-competitive contract terms, it aims to bring more transparency and balance into the marketplace, helping small and mid-sized practices negotiate more fairly.
✅ Why It Matters to You
This legislation would give providers more flexibility to:
Set fair, market-based prices for out-of-pocket services
Push back against rigid fee schedules tied to insurance contracts
Improve profitability on treatments that require time, expertise, and overhead
And for patients, it could mean clearer bills, more flexible payment options, and better access to the treatments they need, not just the ones a carrier chooses to support.
✅ Stay Ahead, Whether the Bill Passes or Not
While the bill is still in committee, the intent is clear: Congress is listening to providers. Whether it moves forward or not, it’s a reminder that practices need to evaluate their payer contracts and billing strategies regularly.
If you’re struggling with insurance-driven pricing limits or want a second set of eyes on your insurance verification or billing workflows, our team at Paragon Dental Solutions is here to help.
Let’s make sure you’re getting paid fairly, for the work you already do.
-Paragon Dental Solutions
Billing. Insurance. Resolved.
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