This bill addresses the relationship between dental healthcare providers and insurers, specifically focusing on the processes surrounding claims and prior authorizations. It mandates that any review, audit, or investigation by a nonprofit dental service corporation regarding claims must be completed within six months of the claims being paid. Additionally, the bill prohibits insurers from denying claims for procedures that have already received prior authorization, unless specific conditions are met, such as changes in the patient's condition or documentation issues.

The bill also amends existing law regarding contracts between health insurers and dentists. It removes the requirement that contracts issued or renewed after July 1, 2010, must include provisions that set fees for services provided by dentists. Furthermore, it ensures that contracts cannot limit fees for non-covered services or prevent dentists from billing patients for necessary services that are denied by insurers. The bill aims to enhance transparency and fairness in dental insurance practices while protecting the rights of both providers and patients.

Statutes affected:
As introduced: 40-2