§ 27-18-63. Dental insurance assignment of benefits.
Every entity providing a policy of accident and sickness insurance as defined in this
chapter shall allow, as a provision in a group or individual policy, contract, or
health benefit plan for coverage of dental services, any person insured by such entity
to direct, in writing, that benefits from a health benefit plan, policy, or contract,
be paid directly to a dental care provider who has not contracted with the entity
to provide dental services to persons covered by the entity but otherwise meets the
credentialing criteria of the entity and has not previously been terminated by such
e
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§ 27-18-63. Dental insurance assignment of benefits.
Every entity providing a policy of accident and sickness insurance as defined in this
chapter shall allow, as a provision in a group or individual policy, contract, or
health benefit plan for coverage of dental services, any person insured by such entity
to direct, in writing, that benefits from a health benefit plan, policy, or contract,
be paid directly to a dental care provider who has not contracted with the entity
to provide dental services to persons covered by the entity but otherwise meets the
credentialing criteria of the entity and has not previously been terminated by such
entity as a participating provider. If written direction to pay is executed and written
notice of the direction to pay is provided to such entity, the insuring entity shall
pay the benefits directly to the dental care provider. Any efforts to modify the amount
of benefits paid directly to the dental care provider under this section may include
a reduction in benefits paid of no more than five percent (5%) less than the benefits
paid to participating dentists. The entity paying the dentist, pursuant to a direction
to pay duly executed by the subscriber, shall have the right to review the records
of the dentist receiving such payment that relate exclusively to that particular subscriber/patient
to determine that the service in question was rendered. Provided, however, this section
shall not apply to insurance coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified disease indemnity;
(8) Sickness or bodily injury or death by accident or both; and
(9) Other limited benefit policies.