9 states enacting dental benefit laws

Nine states have implemented new dental benefit laws, tackling issues including assignment of benefits, claims review transparency and medical loss ratios.

Many of the laws were supported by the American Dental Association's State Public Affairs program, which helps state dental associations improve their communications and public affairs capabilities, according to a June 19 news release from the ADA. 

Here are the nine states that established dental benefit laws:


  • Passed House Bill 2444, which prohibits insurers' disallow clauses that allow denials on claim payments and prohibits billing patients for dental services. The bill also requires the state to make claim grievance information resolution statistics public.
  • Passed Senate Bill 1070, which requires insurers to follow the provider's decision on payment methods on a continual basis.


  • Enacted Senate Bill 892, which prohibits insurers from denying claims for procedures that were included in a prior authorization. The bill also prevents insurers from limiting payment to credit cards only. 


  • Passed Senate Bill 132, which requires insurers comply with patient requests to send claim payments directly to the dentist. 


  • Enacted House File 2400, which requires insurers paying with virtual credit cards to make the provider aware of any fees associated with each payment method, options for payment methods and give clear instructions on how to choose an alternative payment method. In addition, third-party leasing networks must follow the provisions in the dentist's original contract.


  • Enacted Senate Bill 463, which requires insurers to file a dental loss ratio report each year. Insurers are also required to disclose the number of enrollees in their plans, the plan cost sharing figures, deductible amounts, annual maximum coverage limits and the number of enrollees who meet or exceed annual coverage limits.


  • Passed Senate Bill 791, which increases dental insurance transparency in the state. The bill requires insurance carriers to provide contact information for claims and detailed explanations for denials when requested.


  • Passed House Bill 677, which prohibits insurers from having a plan that uses downcoding that prevents the provider from collecting a fee for services performed. The bill also prohibits certain bundling procedures. In addition, the bill prevents benefit plans from having restrictions in which the only acceptable method of payment is a credit card.


  • Passed House Bill 1132, which requires dental carriers to annually report medical loss ratios to insurance regulators in the state.


  • Assembly Bill 62 requires insurers to pay a dentist directly, whether they are in network or not, when the enrollee requests the insurer to do so.

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.