Internet Addresses for State Dental Laws
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
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