DOC Access Act
Dentist and Optometric Care Access Act or the DOC Access Act
This bill amends the Public Health Service Act to prohibit group health plans and individual health insurance coverage from setting rates for items and services provided by a doctor of optometry, of dental surgery, or of dental medicine for which the plan or insurer does not pay a substantial amount.
An agreement between a plan or insurer and such a doctor: (1) may only be changed with the doctor's acknowledgement and acceptance, and (2) may last longer than two years only with the prior acceptance of the doctor for each term extension if the agreement is for limited scope dental or vision benefits.
Such a doctor must be allowed to participate in: (1) a plan or coverage without accepting terms for ancillary services or procedures, and (2) a provider network without participating in a specific limited scope dental or vision benefit plan.
Plans and insurers may not: (1) directly communicate with an enrolled individual in a manner that interferes with an existing doctor-patient relationship or a state or federal requirement, or (2) restrict such a doctor's choice of laboratories or suppliers.
The bill establishes a private right of action for a person adversely affected by a violation of this bill.
The bill is preempted by state laws regarding health insurers and dental or vision benefit plans.
Referred to the Subcommittee on Health.