SB 1377 Signed by Governor

Posted on 04/22/2016

Thank you
to everyone who attended ODA’s Dentist Day at the Capitol and made phone calls/sent emails when prompted! The new law is effective November 1, 2016. 

Senate Bill 1377 will require insurance companies to provide information to dentists to identify the third parties that leased the provider networks prior to the completion of the dental services. 

Additionally, this act will require the insurance companies to be transparent in the following ways:

  • A contracting entity shall not sell, assign, or otherwise grant access to the dental services of a participating provider under a health care contract unless expressly authorized by the health care contract. The health care contract shall specifically provide that one purpose of the contract is the selling, assigning, or giving the contracting entity rights to the services of the participating provider, including network plans.
  • Upon entering a contract with a participating provider and upon request by a participating provider, a contracting entity shall properly identify any third party that has been granted access to the dental services of the participating provider.
  • A contracting entity that sells, assigns, or otherwise grants access to the dental services of a participating provider shall maintain an internet website or a toll-free telephone number through which the participating provider may obtain information which identifies the insurance carrier to be used to reimburse the participating provider for the covered dental services.
  • A contracting entity that sells, assigns, or otherwise grants access to a participating provider's dental services shall ensure that an explanation of benefits or remittance advice furnished to the participating provider that delivers dental services under the health care contract identifies the contractual source of any applicable discount.
  • All third parties that have contracted with a contracting entity to purchase, be assigned, or otherwise be granted access to the participating provider's discounted rate shall comply with the participating provider's contract, including all requirements to encourage access to the participating provider, and pay the participating provider pursuant to the rates of payment and methodology set forth in that contract, unless otherwise agreed to by a participating provider.

ADA News

Click here
to read the ADA News article published on May 10, 2016.