# The DOC Access Act of 2021: What It Means for Your Dental and Vision Care

This bill is about protecting your rights when you see dentists and eye doctors who work with your insurance plan. Right now, when you visit a dentist or optometrist that's in your insurance network, they can only charge you what your insurance allows for covered services. But if they want to provide something your plan doesn't cover—like cosmetic dental work or a specific type of lens—they can charge you whatever they want. This bill sets some new rules around those out-of-pocket charges and gives you legal protection if insurance companies or doctors break these rules.

The main changes are straightforward. First, if a dentist or eye doctor in your network charges you for something your insurance doesn't cover, they can only charge you their "usual and customary" rate—basically what they'd charge someone without insurance. There's one important exception: dental cleanings always have to be charged at the network rate, even if you've already hit your annual cleaning limit. Second, the bill says insurance companies can't tell dentists or eye doctors which labs or suppliers they have to use. Right now, some plans restrict which labs can make your glasses or dental work, and this bill prevents that. Third, if you have a limited dental or vision plan (the kind that only covers basic stuff), the insurance company can't force the dentist or eye doctor to renew the contract unless the provider agrees to it each time.

If an insurance company or provider violates these rules, you can actually sue them in federal court. If you win, you can get up to $1,000 per day the violation occurred, plus attorney fees and court costs. However, individual dentists and eye doctors can opt out of these requirements for a year at a time if they choose to. The bill also makes clear that states can enforce their own dental and vision insurance laws if those laws are stricter than what this bill requires.

DOC Access Act of 2021

Clarke, Yvette D.

Dentist and Optometric Care Access Act of 2021 or the DOC Access Act of 2021 This bill prohibits private health insurance plans from setting rates for items and services, except for dental cleanings, provided by a doctor of optometry, of dental surgery, or of dental medicine for which the plan does not pay a substantial amount. Additionally, an agreement between a plan and such a doctor for limited scope dental or vision benefits may last longer than two years only with the prior acceptance of the doctor for each term extension. Plans also may not restrict such a doctor's choice of laboratories or suppliers. Such doctors may elect to waive the application of the payment amount and choice of laboratories provisions of this bill. The bill establishes a private right of action for a person adversely affected by a violation of this bill. The bill does not supersede state laws regarding health insurers and dental or vision benefit plans.