Report Title:

Dentists; Assignment of Payment; Disclosure

 

Description:

Allows patients to assign insurance benefit payments for dental services to a dentist who is not a participating provider. Requires a nonparticipating provider to give written disclosure to a patient that includes a good faith estimate of out-of-pocket charges. (SD2)

HOUSE OF REPRESENTATIVES

H.B. NO.

2618

TWENTY-FIRST LEGISLATURE, 2002

H.D. 1

STATE OF HAWAII

S.D. 2


 

A BILL FOR AN ACT

 

RELATING TO INSURANCE.

 

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

SECTION 1. The legislature finds that accessibility and affordability of proper dental services is a continuing problem in this State. The lack of good dental care can lead to other more serious health problems, ultimately resulting in higher medical costs and deteriorating health conditions. While access is not a problem unique to Hawaii, it is imperative that solutions be adopted and implemented in order to prevent further decline.

One way to improve access to dental care is to give patients the option of going to their practitioner of choice-– the dentist that they know and trust. Currently, this is not possible if that dentist is not a participant in the patient's health insurance plan. Often under such circumstances, the patient would have to pay the dentist first and wait to receive reimbursement from the insurer. In most cases, the amount reimbursed is less than the amount that would have been paid if the dentist were a participating dentist.

The situation becomes even more critical when a patient has to be seen by a specialist, especially in an emergency. For example, a patient who needs to have a root canal and is referred to a specialist but is limited to seeing only a specialist who is a participant in that patient's health insurance plan. That requirement can result in delays, additional pain and discomfort, and increased risk to the patient.

The purpose of this Act is to give patients the option of having their insurance reimbursement sent directly to a dentist of their choice, regardless of whether the dentist is a preferred provider, greatly enhancing the patient's access to quality care without increasing costs to the insurer or the patient.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A- Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured. The insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Prior to treatment, a nonparticipating provider shall disclose to the insured that the provider does not participate in the insured's dental services plan. The disclosure shall be in writing, shall include language stating that the insured will not be covered by the protections that apply to members of the insured's dental services plan, and shall provide a good faith estimate of the insured's out-of-pocket costs for the services to be provided. Upon written request, an insurer shall provide a schedule of its eligible charges to the nonparticipating provider. The disclosure statement shall be provided separate and apart from any other information provided to the insured and shall be signed by the insured prior to services being rendered. An insurer shall not be obligated to make payments directly to the provider unless the insurer receives the signed disclosure from the provider or the insured.

(d) Nothing in this section shall be construed to limit an insurer from determining the scope of the insurer's benefits, services, or other terms contained in the insurer's contracts except as provided in this section.

(e) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

"§432:1- Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured. The insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Prior to treatment, a nonparticipating provider shall disclose to the insured that the provider does not participate in the insured's dental services plan. The disclosure shall be in writing, shall include language stating that the insured will not be covered by the protections that apply to members of the insured's dental services plan, and shall provide a good faith estimate of the insured's out-of-pocket costs for the services to be provided. Upon written request, an insurer shall provide a schedule of its eligible charges to the nonparticipating provider. The disclosure statement shall be provided separate and apart from any other information provided to the insured and shall be signed by the insured prior to services being rendered. An insurer shall not be obligated to make payments directly to the provider unless the insurer receives the signed disclosure from the provider or the insured.

(d) Nothing in this section shall be construed to limit an insurer from determining the scope of the insurer's benefits, services, or other terms contained in the insurer's contracts except as provided in this section.

(e) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D-    Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured. The insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Prior to treatment, a nonparticipating provider shall disclose to the insured that the provider does not participate in the insured's dental services plan. The disclosure shall be in writing, shall include language stating that the insured will not be covered by the protections that apply to members of the insured's dental services plan, and shall provide a good faith estimate of the insured's out-of-pocket costs for the services to be provided. Upon written request, an insurer shall provide a schedule of its eligible charges to the nonparticipating provider. The disclosure statement shall be provided separate and apart from any other information provided to the insured and shall be signed by the insured prior to services being rendered. An insurer shall not be obligated to make payments directly to the provider unless the insurer receives the signed disclosure from the provider or the insured.

(d) Nothing in this section shall be construed to limit an insurer from determining the scope of the insurer's benefits, services, or other terms contained in the insurer's contracts except as provided in this section.

(e) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect on January 1, 2050.