Permits a patient to direct an insurer plan to directly reimburse
a nonparticipating dental provider.

HOUSE OF REPRESENTATIVES                H.B. NO.           
TWENTIETH LEGISLATURE, 2000                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Chapter 431, Hawaii Revised Statutes, is amended
 2 by adding a new section to article 10A to be appropriately
 3 designated and to read as follows:
 4      "431:10A-     Dental services; reimbursement.  (a)  An
 5 insured may assign reimbursement for dental services directly to
 6 the provider of services.
 7      (b)  Upon notification by the insured, the insurer shall
 8 reimburse the provider for dental services provided to the
 9 insured.  The insurer shall reimburse the provider regardless of
10 whether the provider is a participating provider with the
11 insurer.
12      (c)  If an insurer fails to reimburse the provider pursuant
13 to this section, the insurer shall be liable for interest in the
14 amount of one per cent per month or any part of a month thereof
15 commencing from the date the claim and assignment of the claim is
16 received by the insurer; provided that this subsection shall not
17 apply if the insurer reimburses the provider within twenty-one
18 days from the date the claim and assignment of the claim is
19 received by the insurer.  The interest shall accrue until the
20 full amount of the claim is received by the provider.

Page 2                                                     2833
                                     H.B. NO.           

 1      (d)  This section shall not apply to claims in which there
 2 is a dispute regarding the legitimacy of the claim, and the
 3 insurer does both of the following:
 4      (1)  Notifies the provider within two weeks of the receipt
 5           of the claim and the assignment that there is a dispute
 6           and specifies the reason or reasons for the dispute;
 7           and
 8      (2)  Pays any undisputed portion of the claim within thirty
 9           days of receipt of the claim and the assignment, and
10           makes a timely, good faith effort to resolve any
11           difference between the insurer and provider.
12      (e)  Nothing in this section shall be construed to limit any
13 insurer from determining the scope of its benefits, services, or
14 any other terms contained in the insurer's contracts except as
15 provided in this section.
16      (f)  As used in this section:
17      "Participating provider" means a provider that contracts
18 with an insurer to provide services to insureds.
19      "Provider" means a dentist licensed to practice in Hawaii
20 under chapter 448."
21      SECTION 2.  New statutory material is underscored.
22      SECTION 3.  This Act shall take effect upon its approval.
24                           INTRODUCED BY:  _______________________