Permits a patient to direct a insurer to directly reimburse a
nonparticipating dental provider at the same rate as a
participating provider.

THE SENATE                              S.B. NO.           782
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            

                   A  BILL  FOR  AN  ACT



 1      SECTION 1.  Chapter 431:10A, Hawaii Revised Statutes, is
 2 amended by adding a new section to be appropriately designated
 3 and to read as follows:
 4      "431:10A-     Dental services; reimbursement.  (a)  An
 5 insured may assign reimbursement for dental services directly to
 6 the provider of services.
 7      (b)  Upon notification by the insured, the insurer shall
 8 reimburse the provider for dental services provided to the
 9 insured.  The insurer shall reimburse the provider regardless of
10 whether the provider is a participating provider with the
11 insurer; provided that if the provider is a nonparticipating
12 provider, the insurer shall reimburse the nonparticipating
13 provider under the same criteria and payment schedule as a
14 participating provider.
15      (c)  If an insurer fails to reimburse the provider pursuant
16 to this section, the insurer shall be liable for interest in the
17 amount of one per cent per month or any part of a month thereof
18 commencing from the date the claim and assignment of the claim is
19 received by the insurer; provided that this subsection shall not

Page 2                                                     
                                     S.B. NO.           782

 1 apply if the insurer reimburses the provider within twenty-one
 2 days from the date the claim and assignment of the claim is
 3 received by the insurer.  The interest shall accrue until the
 4 full amount of the claim is received by the provider.
 5      (d)  This section shall not apply to claims in which there
 6 is a dispute regarding the legitimacy of the claim, and the
 7 insurer does both of the following:
 8      (1)  Notifies the provider within two weeks of the receipt
 9           of the claim and the assignment that there is a dispute
10           and specifies the reason or reasons for the dispute;
11           and
12      (2)  Pays any undisputed portion of the claim within thirty
13           days of receipt of the claim and the assignment, and
14           makes a timely, good faith effort to resolve any
15           difference between the insurer and provider.
16      (e)  Nothing in this section shall be construed to limit any
17 insurer from determining the scope of its benefits, services, or
18 any other terms contained in the insurer's contracts except as
19 provided in this section.
20      (f)  As used in this section:
21      "Participating provider" means a provider that contracts
22 with an insurer to provide services to insureds.
23      "Provider" means a dentist licensed to practice in Hawaii

Page 3                                                     
                                     S.B. NO.           782

 1 under chapter 448."
 2      SECTION 2.  New statutory material is underscored.
 3      SECTION 3.  This Act shall take effect upon its approval.
 5                           INTRODUCED BY:  _______________________