The bill amends the "Unfair Claims Settlement Practices Act" to include new provisions specifically addressing unfair practices related to dental insurance claims. It establishes that it is an unfair claims practice for a dental insurer to refuse to honor a direction to pay executed by an insured or claimant for dental services, regardless of whether the dental service provider is contracted with the insurer, provided that the dental service provider meets the insurer's credentialing criteria and has not been previously terminated as a participating provider. The bill also prohibits insurers from modifying the amount of benefits paid directly to the dental service provider compared to what is paid to the majority of participating providers. Additionally, it allows insurers to review the records of the dental service provider to confirm that services were rendered, but prohibits any efforts to modify the amount of benefits paid.

Furthermore, the bill includes provisions that prevent insurers from requiring dental service providers to accept payments exclusively via virtual credit card. Insurers are required to inform dental service providers of alternative payment methods and provide clear instructions for selecting an alternative payment method. The insurer or its healthcare payments platform is also prohibited from charging the dental service provider any fee for access to payment or claims data or for the transmission, processing, or mailing of the payment. The act is set to take effect upon passage.

Statutes affected:
905: 27-9.1-4