ADA Urges Senate Finance to Set Dental-Specific Prior Authorization Standards

Edited by Orthotown staff

The American Dental Association has asked the Senate Finance Committee to adopt dental-specific standards for prior authorization, claims, denials, appeals, and payment. The request came in Sept. 29 comments responding to a request for information from Ranking Member Ron Wyden, D-Ore.

The association said federal reforms should account for dental coding, terminology, and workflows. It also said clinical dental determinations should be made or reviewed by a U.S.-licensed dentist, with appropriate specialty expertise when necessary. In the letter, the ADA wrote that a dental benefit should not be denied or reduced solely because preauthorization was not obtained when the patient otherwise qualifies, and that routine diagnostic and preventive services should not be subject to unnecessary preauthorization.

The ADA also asked the committee to let states, through their insurance regulators, seek federal approval to apply specified dental insurance protections to employer self-funded plans and the entities that administer them. Prior authorization is among the protections it listed, along with:

• prompt-payment standards

• limits on fees for noncovered services

• limits on retroactive denials and recoupments

• network-leasing transparency

• provider-directory accuracy

According to the letter, states have enacted 400 dental insurance reforms. The ADA said carriers and administrators of self-funded plans frequently assert that the Employee Retirement Income Security Act preempts them from following those laws. The request for information, titled “Health Coverage That Works for Everyone,” asks whether states should have waiver authority over portions of the self-insured market.

Other recommendations cover three areas:

• Administrators. Oversight of third-party administrators and of entities that lease dental networks or reprice claims.

• Loss ratios. Public loss-ratio reporting for stand-alone dental plans.

• Medicare Advantage. Closer oversight of supplemental dental benefits.

ADA President Richard Rosato and Executive Director Nader Nadershahi signed the letter. It also restated the association’s support for H.R. 7931, the Improving Dental Administration Act, which would exempt certain state dental benefit laws from ERISA preemption.

Sources:
American Dental Association, letter to Senate Finance Committee Ranking Member Ron Wyden, Sept. 29, 2026: ada.org/september_29_2026_letter_to_senate_finance.pdf
ADA News, “ADA urges Senate Finance Committee to include dental in insurance reforms,” Sept. 30, 2026: adanews.ada.org/2026/october/senate-finance-dental-insurance-reforms