Iowa Dental Insurers Can't Limit Fees for Non-covered Dental Services

In May of 2013, the Iowa Supreme Court ruled that Iowa law does not allow dental insurers to set maximum fees on services that the insurer does not cover or reimburse, even if the insurer does not reimburse for a service that would be a covered service, except for the fact that the patient has reached a contractual limitation such as an annual maximum or frequency limitation.

Once a patient exhausts the maximum benefit for a particular dental service, the insurer cannot cap the fee the dentist may charge the patient for that dental service for the balance of the coverage period. For example, if a dental plan pays, in whole or in part, for two teeth cleanings per year and the patient requests a third cleaning during the twelve-month term, the patient is off the plan; for the third cleaning and the insurer cannot dictate to the treating dentist what his fee to the patient for the third cleaning will be.

As your insurer, we will have no involvement in setting the fees for non-covered dental services. Please contact your dentist with any questions or concerns about fees for non-covered services.