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, allowing payments for dental services to be made directly to the dental service provider, regardless of whether the 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, ensuring that these payments are consistent with those made to the majority of participating providers. Insurers are granted the right to review the records of the dental service provider receiving such payment to confirm that the services were rendered.

Additionally, the bill prohibits requiring dental service providers to accept payments exclusively through virtual credit cards and mandates that insurers inform dental service providers of alternative payment methods, providing clear instructions for selecting an alternative payment method. Insurers or their healthcare payments platforms are also prohibited from charging dental service providers any fees 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, enhancing consumer protections in the insurance sector, particularly for dental services.

Statutes affected:
905: 27-9.1-4