Internet Addresses for State Dental Laws

AL
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CA
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CT 1 2
DE
DC 1 2
FL
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ID
IL
IN
IA 1 2 3
KS


Non-Covered Services


States That Prohibit Insurance Carriers From Dictating Cost

In the insurance world, a non-covered service is defined as a procedure that is not covered by the patient’s insurance plan. The definition may sound obvious and somewhat elementary but non-covered services have been a controversial topic of discussion in both the dental and medical industry for the past decade!

Let’s use the State of Rhode Island as an example. Up until 2009, doctors who were contracted with insurance plans as Participating Providers (in-network Providers) were not allowed to charge their full office fee for procedures not covered by the patient’s insurance plan. Instead, insurance carriers were dictating that Participating Providers follow the maximum allowable fee table/schedule that the doctor agreed to when he/she contracted to become a Preferred Participating Provider of the insurance plan. Since insurers were requiring Participating Providers to discount their fees by up to 60% (and up to 80% for procedures not covered by a patients insurance plan), only a small number of doctors from a few states took action by getting their respective state’s law makers involved in creating a law that prohibited insurance carriers from dictating charges for services/procedures not covered by a patient’s insurance plan.

The following is a list of states that passed a non-covered service law prohibiting insurance carriers from determining discounts and fees, or procedures not covered by a patient’s insurance plan. In other words, if you practice in any of these states and you are a Participating Provider of any insurance plan you are now permitted to charge your full office fee for procedures not covered by a patient’s insurance plan:

State (Click on a State to View the Actual Law) and Effective Date of Legislation

1) Rhode Island June 18, 2009

2) Oregon March 18, 2010

3) Washington June 10, 2010

4) Idaho July 1, 2010

5) Iowa July 1, 2010

6) Kansas July 1, 2010

7) Mississippi July 1, 2010

8) South Dakota July 1, 2010

9) Virginia July 1, 2010

10) Nebraska July 16, 2010

11) North Carolina July 21, 2010

12) Alaska September 13, 2010

13) Oklahoma November 1, 2010

14) Louisiana January 1, 2011

15) Arizona January 1, 2011

16) California January 1, 2011

17) Arkansas March 22, 2011

18) New Mexico April 7, 2011

19) Tennessee May 23, 2011

20) Wyoming July 1, 2011

21) Georgia July 1, 2011

22) Minnesota August 1, 2011

23) North Dakota August 1, 2011

24) Texas September 1, 2011

25) Maryland October 1, 2011

26) Connecticut January 1, 2012

27) Kentucky July 11, 2012

28) Pennsylvania December 24, 2012

29) Illinois January 1, 2013

30) Montana July 1, 2013

31) Wisconsin January 1, 2014

Thank you Rhode Island for leading the way!

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