REPORT TITLE:
Dentists


DESCRIPTION:
Permits a patient to direct a health insurer, mutual benefit
society, or health maintenance organization to directly reimburse
a nonparticipating dental provider, effective July 1, 2001. (SD1)  

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        783
THE SENATE                              S.B. NO.           S.D. 1
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
________________________________________________________________
________________________________________________________________


                   A  BILL  FOR  AN  ACT

RELATING TO DENTAL INSURANCE. 


BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 431:10A, Hawaii Revised Statutes, is
 
 2 amended by adding a new section to be appropriately designated
 
 3 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
 

 
Page 2                                                     783
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 full amount of the claim is received by the provider.
 
 2      (d)  This section shall not apply to claims in which there
 
 3 is a dispute regarding the legitimacy of the claim, and the
 
 4 insurer does both of the following:
 
 5      (1)  Notifies the provider within two weeks of the receipt
 
 6           of the claim and the assignment that there is a dispute
 
 7           and specifies the reason or reasons for the dispute;
 
 8           and
 
 9      (2)  Pays any undisputed portion of the claim within thirty
 
10           days of receipt of the claim and the assignment, and
 
11           makes a timely, good faith effort to resolve any
 
12           difference between the insurer and provider.
 
13      (e)  Nothing in this section shall be construed to limit any
 
14 insurer from determining the scope of its benefits, services, or
 
15 any other terms contained in the insurer's contracts except as
 
16 provided in this section.
 
17      (f)  As used in this section:
 
18      "Participating provider" means a provider that contracts
 
19 with an insurer to provide services to insureds.
 
20      "Provider" means a dentist licensed to practice in Hawaii
 
21 under chapter 448."
 
22      SECTION 2.  Chapter 432:1, Hawaii Revised Statutes, is
 
23 amended by adding a new section to be appropriately designated
 

 
Page 3                                                     783
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 and to read as follows:
 
 2      "432:1-     Dental services; reimbursement.  (a)  A member
 
 3 may assign reimbursement for dental services directly to the
 
 4 provider of services.
 
 5      (b)  Upon notification by the member, the mutual benefit
 
 6 society shall reimburse the provider for dental services provided
 
 7 to the member.  The mutual benefit society shall reimburse the
 
 8 provider regardless of whether the provider is a participating
 
 9 provider with the mutual benefit society.
 
10      (c)  If a mutual benefit society fails to reimburse the
 
11 provider pursuant to this section, the mutual benefit society
 
12 shall be liable for interest in the amount of one per cent per
 
13 month or any part of a month thereof commencing from the date the
 
14 claim and assignment of the claim is received by the mutual
 
15 benefit society; provided that this subsection shall not apply if
 
16 the mutual benefit society reimburses the provider within twenty-
 
17 one days from the date the claim and assignment of the claim is
 
18 received by the mutual benefit society.  The interest shall
 
19 accrue until the full amount of the claim is received by the
 
20 provider.
 
21      (d)  This section shall not apply to claims in which there
 
22 is a dispute regarding the legitimacy of the claim, and the
 
23 mutual benefit society does both of the following:
 

 
Page 4                                                     783
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1      (1)  Notifies the provider within two weeks of the receipt
 
 2           of the claim and the assignment that there is a dispute
 
 3           and specifies the reason or reasons for the dispute;
 
 4           and
 
 5      (2)  Pays any undisputed portion of the claim within thirty
 
 6           days of receipt of the claim and the assignment, and
 
 7           makes a timely, good faith effort to resolve any
 
 8           difference between the mutual benefit society and
 
 9           provider.
 
10      (e)  Nothing in this section shall be construed to limit any
 
11 mutual benefit society from determining the scope of its
 
12 benefits, services, or any other terms contained in the mutual
 
13 benefit society's contracts except as provided in this section.
 
14      (f)  As used in this section:
 
15      "Participating provider" means a provider that contracts
 
16 with a mutual benefit society to provide services to members.
 
17      "Provider" means a dentist licensed to practice in Hawaii
 
18 under chapter 448."
 
19      SECTION 3.  Chapter 432D, Hawaii Revised Statutes, is
 
20 amended by adding a new section to be appropriately designated
 
21 and to read as follows:
 
22      "432D-     Dental services; reimbursement.  (a)  An
 
23 enrollee may assign reimbursement for dental services directly to
 

 
Page 5                                                     783
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1 the provider of services.
 
 2      (b)  Upon notification by the enrollee, the health
 
 3 maintenance organization shall reimburse the provider for dental
 
 4 services provided to the enrollee.  The health maintenance
 
 5 organization shall reimburse the provider regardless of whether
 
 6 the provider is a participating provider with the health
 
 7 maintenance organization.
 
 8      (c)  If a health maintenance organization fails to reimburse
 
 9 the provider pursuant to this section, the health maintenance
 
10 organization shall be liable for interest in the amount of one
 
11 per cent per month or any part of a month thereof commencing from
 
12 the date the claim and assignment of the claim is received by the
 
13 health maintenance organization; provided that this subsection
 
14 shall not apply if the health maintenance organization reimburses
 
15 the provider within twenty-one days from the date the claim and
 
16 assignment of the claim is received by the health maintenance
 
17 organization.  The interest shall accrue until the full amount of
 
18 the claim is received by the provider.
 
19      (d)  This section shall not apply to claims in which there
 
20 is a dispute regarding the legitimacy of the claim, and the
 
21 health maintenance organization does both of the following:
 
22      (1)  Notifies the provider within two weeks of the receipt
 
23           of the claim and the assignment that there is a dispute
 

 
Page 6                                                     783
                                     S.B. NO.           S.D. 1
                                                        
                                                        

 
 1           and specifies the reason or reasons for the dispute;
 
 2           and
 
 3      (2)  Pays any undisputed portion of the claim within thirty
 
 4           days of receipt of the claim and the assignment, and
 
 5           makes a timely, good faith effort to resolve any
 
 6           difference between the health maintenance organization
 
 7           and provider.
 
 8      (e)  Nothing in this section shall be construed to limit any
 
 9 any health maintenance organization from determining the scope of
 
10 its benefits, services, or any other terms contained in the
 
11 health maintenance organization's contracts except as provided in
 
12 this section.
 
13      (f)  As used in this section:
 
14      "Participating provider" means a provider that contracts
 
15 with a health maintenance organization to provide services to
 
16 enrollees.
 
17      "Provider" means a dentist licensed to practice in Hawaii
 
18 under chapter 448."
 
19      SECTION 4.  New statutory material is underscored.
 
20      SECTION 5.  This Act, upon its approval, shall take effect
 
21 on July 1, 2001.