Thanks to the hard work and determination of your LDA leadership, the LDA lobbying team moved forward during the hectic, 28-day legislative session with two of our pieces of insurance legislation. Members from all over the state called their legislators and responded to our call-to-action alerts. The ADA also supported our efforts as part of the State Public Affairs program.
Our advocacy efforts worked; this is organized dentistry at its finest - promoting, advocating and protecting the dental profession!
As of today, the Governor signed both bills, and they are effective on August 1, 2020.
HB311 (now Act 256) by Rep. Mike Huval – Prohibits the denial of claims based upon preexisting conditions. Also called the “missing tooth clause” bill, HB311 prevents a dental service contractor from denying a benefit for covered dental services to treat conditions existing prior to the date the coverage begins. A dental service contractor may impose up to a 12-month waiting period for covered services.
HB353 (now Act 187) by Rep. Chad Brown – Prohibits a dental service contractor (third party payer) from systematically downcoding with the intent to deny reimbursement otherwise due to a dentist or other healthcare provider. It also prohibits downcoding the installation service of a fixed bridge to a removable bridge.
Additionally, if a procedure code change is made, the explanation of benefits (EOB) provided to the patient shall include the reason for the downcoding and citation of the dental service contractor's applicable policy. The EOB shall not state or infer that the code billed by the dentist or other healthcare provider was inappropriate unless there is clear evidence the code listed on the claim by the provider in no way related to the procedure performed. The EOB shall not state or infer that the healthcare provider's charge was excessive unless there is clear evidence the charge was substantially higher than the provider's regular fees. The third party payer shall disclose in its provider contracts, on its website, or both, the specific downcoding policies that the dental service contractor reasonably expects to be applied to the provider or provider's services on a routine basis as a matter of policy.
