Texas dentists are seeing firsthand why closing the ERISA loophole matters.

A recent payment policy change by Aetna has highlighted the ongoing challenges dentists face when state consumer protections do not apply to self-funded dental benefit plans governed by the Employee Retirement Income Security Act (ERISA). At the same time, momentum is building in Congress to address this issue through the Improving Dental Administration (IDA) Act.

Aetna Payment Policy Change

Aetna recently implemented a virtual credit card (VCC) payment policy that was first piloted in Georgia and has now expanded to Texas.

For state-regulated plans, Texas law protects dentists. Thanks to legislation championed by TDA in 2019 (Texas Insurance Code §1451.206(a)(1)(A-C)), insurers must offer at least one payment method that delivers 100% of the contracted payment with no fee to the provider.

If your practice receives payments through Aetna's VCC program, you may notify Aetna in writing that you do not accept VCC or Electronic Funds Transfer (EFT) as your payment method and cite the Texas statute. If Aetna does not comply, TDA encourages members to file a complaint with the Texas Department of Insurance.

For ERISA-governed, self-funded plans, however, these state protections do not apply. Practices may still choose to formally refuse VCC and EFT payments in writing, as withholding payment could raise fiduciary concerns for the plan. However, this inconsistency is exactly why federal reform is needed.

If your practice files a complaint with the Texas Department of Insurance or receives a response from Aetna, please let TDA know. Your experiences help strengthen our advocacy efforts and inform our discussions with regulators and policymakers.

Progress on Federal ERISA Reform

There is encouraging news on the federal front.

Congressman Brian Babin (R-TX-36) has signed on as a cosponsor of the Improving Dental Administration (IDA) Act (H.R. 7931), legislation that would close the ERISA loophole and restore fairness in dental benefit administration.

Currently, insurance carriers can use ERISA preemption to bypass many of the patient and provider protections Texas has enacted into law, including:

• Non-covered services protections

• Virtual credit card payment protections

• Network leasing restrictions

• Assignment of benefits protections

• Prior authorization continuity requirements

The IDA Act would ensure these state protections apply to self-funded plans while preserving federal oversight of benefit design.

Congressman Babin's support is the direct result of advocacy from organized dentistry and Texas dentists who responded to TDA's calls for action.

TDA Is Working for You

Whether advocating before the Texas Legislature, working alongside the American Dental Association on federal reforms, or helping members navigate insurance challenges as they arise, TDA remains committed to protecting dentists and their patients.