The bill amends the Wyoming insurance code to establish specific requirements for dental insurance billing and coding practices. It prohibits dental insurance providers from imposing certain restrictions on dentists, such as requiring them to provide services at a contractually set fee for non-covered services, using downcoding to limit fees for actual services performed, and employing bundling practices that mislabel procedure codes. Additionally, the bill mandates that any adjustments to procedure codes must be justified and communicated clearly to the subscriber, and it requires transparency regarding downcoding policies in provider contracts and on websites.

Furthermore, the bill introduces definitions for key terms such as "covered services," "bundling," and "downcoding," and it allows dentists, with informed patient consent, to collect fees for services that have been downcoded or denied based on their published fee schedules. The existing subsection (c) of W.S. 26-22-505 is repealed, and the new provisions will apply to contracts, policies, or certificates issued on or after July 1, 2025, without affecting existing agreements made prior to that date. The act is set to take effect on July 1, 2025.

Statutes affected:
Introduced: 26-22-505