§ 27-20-49. Dental insurance assignment of benefits.
Every entity providing a contract of 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 the 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 the entity as a participating
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§ 27-20-49. Dental insurance assignment of benefits.
Every entity providing a contract of 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 the 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 the entity as a participating
provider. If written direction to pay is executed and written notice of the direction
to pay is provided to the 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
the payment that relate exclusively to that particular subscriber/patient to determine
that the service in question was rendered.