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2016 SESSION

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HB 16 Health insurance; payment for services by dentists and oral surgeons.

Introduced by: R. Lee Ware | all patrons    ...    notes | add to my profiles | history

SUMMARY AS PASSED HOUSE:

Insurance; payment for services by dentists and oral surgeons. Requires that reimbursements payable or paid by a dental plan for covered services be reasonable and not provide nominal reimbursement in order to claim that services are covered services under the applicable dental plan. A reimbursement is reasonable if it is the negotiated fee, rate, or reimbursement methodology that is set forth in the contract between a dental plan and a dentist or oral surgeon and is acceptable to the provider. The measure applies to contracts between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after January 1, 2017. The bill contains a delayed effective date of January 1, 2017.

SUMMARY AS INTRODUCED:

Insurance; payment for services by dentists and oral surgeons. Requires that reimbursements payable or paid by a dental plan for covered services be reasonable and not provide nominal reimbursement in order to claim that services are covered services under the applicable dental plan. A reimbursement is reasonable if it is the negotiated fee or rate that is set forth in the participating provider agreement and is acceptable to the provider. The measure applies to contracts between a dental plan and a dentist or oral surgeon for the provision of health care to patients that is entered into, amended, extended, or renewed on or after January 1, 2017. The bill contains a delayed effective date of January 1, 2017.