Advocacy/Engage
2021 ADVOCACY - HB 1154 Dental Insurance Reform
The NDDA introduced House Bill 1154, the Dental Care Bill of Rights – Dental Insurance Reform Bill, to improve transparency and fairness for patients and their dentists. The following issues are addressed in the bill:
1. Retroactive Denial – Fairness in Claim Payment Refund Requests
THE PROBLEM: Dental Insurers can require providers to repay claim payments when the insurers discover they paid a claim mistakenly, even if the claim was processed years ago. This results surprise billing - at the expense of patients. Patients and providers alike should be able to expect timely, accurate billing when working with Dental Insurers.
NDDA SOLUTION: Under HB 1154, Dental Insurers would be limited to 12 months where they can request refunds from providers when they have paid claims in error. As a result, “surprise bills” are limited to a reasonable amount of time (12 months).
2. Prior Authorization – Claim Payments Guarantee
THE PROBLEM: A Dental Insurer’s authorization means they agree to make payment for the service(s) being sought prior to treatment. Dental Insurers sometimes deny or reduce payment for care they previously authorized through a “prior authorization,” reversing their agreement with both patients and providers. When authorized care is denied, this can result in an emergency financial situation for the patient and provider, increasing stress and creating an unnecessary barrier to future care due to lack of trust in the Dental Insurers. Once authorization is granted, patients should have a right to be assured that their procedure will be covered.
NDDA SOLUTION: HB 1154 would hold Dental Insurers accountable to paying what they promised. “Promise to Pay” legislation (HB 1154) ensures that patients have all the information they need so that they can plan for all health care costs. Avoiding surprise costs preserves the trust between patients and their providers, preventing confusion for all parties. Patients are far more likely to seek care if they believe that their dental insurance coverage is reliable.
3. Network Leasing – Fair and Transparent Network Contracting
THE PROBLEM: Insurance carriers can lease or rent the “in-network” relationship they have established with a provider without the provider’s knowledge or consent, significantly impacting the insurance benefits available to their patients. This erodes patient–provider trust, which can lead to assumptions in treatment plans and costs when the provider has no idea a patient is moving in or out of a network. In a typical dental insurance network arrangement, providers are fully engaged as they choose to join a network, allowing providers to understand and negotiate the terms of their agreement. In states that allow network leasing to proceed without adequate protections, the dental insurance network may transfer the rights to a provider’s contract to another dental insurance company without seeking the provider’s knowledge or consent. As a result, providers may not be able to adequately advise patients on financial planning around dental services.
NDDA SOLUTION: HB 1154 would expand transparency before networks are leased and provide an opportunity for providers to accept or refuse these contracts. Specifically, HB 1154 would protect providers’ ability to accept or refuse these contracts, enforces basic fairness and transparency in this contracting and additionally reduce occurrences of unexpected bills following a procedure.
Additional Resources
2021 Advocacy/Legislative Activity
2021 NDDA Final Legislative Report (PDF)
2021 NDDA Legislative Midsession Update (PDF)
2021 NDDA Legislative Bill Tracking (PDF)
HB 1154 Dental Insurance Reform (PDF)
Dental Care Bill of Rights - NDDA Testimony (PDF)
Dental Care Bill of Rights (1 Page) - Issues & Short Explanations(PDF)
Dental Care Bill of Rights - In-Depth Explanations (PDF)
Retroactive Denial - Fairness in Claim Payment Refund Requests (PDF)
Prior Authorization - Claim Payments Guarantee (PDF)
Virtual Credit Card - Fairness in Claim Payment\Transaction Fees (PDF)
Network Leasing - Fair and Transparent Network Contracting (PDF)
Dental Care Bill of Rights - Legal Terms & Long Explanations (PDF)
Dental Care Bill of Rights - Messages and Q&A (PDF)
Dental Care Bill of Rights (1 Page) - Issues & Explanations (PDF)
Dental Care Bill of Rights - Additional Explanations (PDF)
Dental Care Bill of Rights (1 Page) - Five Issues (PDF)
SB 2343 Medicaid Managed Care - NDDA Testimony (PDF)
