Dentistry; Freedom of Choice

Permits dental patients to authorize direct payment of their
claims to their dentists, whether participating in their
insurance plan or not.  Requires equal reimbursement to all

HOUSE OF REPRESENTATIVES                H.B. NO.1599       
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  The legislature finds that the people of Hawaii
 2 are best able to choose the quality of dental care provided to
 3 themselves and their families, and their personal decision should
 4 be free from outside intervention.  The purpose of this Act is to
 5 guarantee patients the freedom to go to the dentist of their
 6 choice, thereby allowing a patient to maintain the relationship
 7 of trust and understanding that has been developed between
 8 patients and their dentists.
 9      SECTION 2.  Chapter 431, Hawaii Revised Statutes, is amended
10 by adding a new section to article 10A to be appropriately
11 designated and to read as follows:
12      "431:10A-     Dental patient protection; freedom to choose
13 dental care providers.  (a)  As used in this section:
14      "Dental care services" means those professional activities
15 provided by dentists licensed in the State under chapter 448.
16      "Dentist or dental care provider" means any person who
17 furnishes dental care services and is duly licensed as a dentist
18 by the State.
19      (b)  The insured, health plan beneficiary, or dental plan

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                                     H.B. NO.1599       

 1 beneficiary may assign reimbursement for health or dental
 2 services directly to the provider of services.  The insurer, when
 3 authorized by the insured, health plan beneficiary, or dental
 4 plan beneficiary, shall pay directly to the dental care provider
 5 the amount of the claim, whether or not the patient's dentist is
 6 a participating or nonparticipating dentist in the insurer's
 7 dental care plan.
 8      (c)  If a provider of insurance coverage fails to comply
 9 with subsection (b), interest shall be payable on the claim
10 commencing on the twenty-first day of receipt of the claim at a
11 rate of one per cent per month or any part of a month thereof
12 until the claim has been paid, without further action by the
13 provider being required, except as provided in subsection (d).
14      (d)  This section does not apply to claims in which there is
15 a dispute regarding the legitimacy of the claim and the insurer:
16      (1)  Notifies the provider within two weeks of the receipt
17           of the claim that the claim is in dispute and specifies
18           which items of the claim are in dispute; and
19      (2)  Pays any undisputed portion of the claim within thirty
20           days of receipt of the claim and makes a timely, good
21           faith effort to resolve differences.
22      (e)  Nothing in this section shall be construed to limit any
23 insurer, health maintenance organization, preferred provider

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                                     H.B. NO.1599       

 1 organization, health care service corporation, mutual benefit
 2 society, or other third party payor from determining the scope of
 3 its benefits or services or any other terms of its group or
 4 individual insured subscriber or enrollee contracts, or from
 5 negotiating contracts with Hawaii licensed dentists on
 6 reimbursement rates or any other lawful matters; provided that
 7 the contract providing coverage to an insured shall not exclude
 8 the right of assignment of benefits to any willing provider."
 9      SECTION 3.  New statutory material is underscored.
10      SECTION 4.  This Act shall take effect upon its approval.
12                           INTRODUCED BY:  _______________________