A new bill in Pennsylvania aims to expand dental insurance transparency by requiring dental insurers to legally stand behind the benefit quotes they give providers and patients, according to an Aug. 4 report from Insurance Business.
Under House Bill 2722, which was introduced July 30, any statement a dental insurer makes about a benefit, verbally, electronically or in writing, would be binding for claim adjudication and patient benefit determination. Exceptions would apply only in cases of fraud, material misrepresentation by the provider or patient, or loss of patient eligibility after the quote was given.
The bill would also require dental insurers to maintain a secure online portal for every licensed dental provider, updated at least every 24 hours and covering at least three years of claims history, including procedures billed, payments, denials and remaining limits.
In the bill, a dental insurer is defined as an entity “offering, administering or underwriting dental insurance benefits” in Pennsylvania.
An insurer that fails to comply would be required to pay the provider’s own office fee, rather than the agreed fee schedule rate, within 30 business days.
If enacted, the law would take effect one year after passage, the report said.
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