Report Title:

Insurance; Dental; Payment

Description:

Permits an insured to assign reimbursement for dental services to the dentist.

THE SENATE

S.B. NO.

2688

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

RELATING TO INSURANCE.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. The legislature finds that accessibility and affordability of proper dental services is a continuing problem in this State. The lack of good dental care can lead to other more serious health problems, ultimately resulting in higher medical costs and deteriorating health conditions. While access is not a problem unique to Hawaii, it is imperative that solutions be adopted and implemented in order to prevent further decline.

One way to improve access to dental care is to give patients the option of going to their practitioner of choice- the dentist that they know and trust. Currently, this is not possible if that dentist is not a participant in the patient's health insurance plan. Often under such circumstances, the patient would have to pay the dentist first and wait to receive reimbursement from the insurer. In most cases, the amount reimbursed is less than the amount that would have been paid if the dentist were a participating dentist.

The situation becomes even more critical when a patient has to be seen by a specialist, especially in an emergency, for example, a patient that needs to have a root canal and is referred to a specialist but is limited to seeing only a specialist who is a participant in that patient's health insurance plan. That requirement can result in delays, additional pain and discomfort, and increased risk to the patient.

The purpose of this Act is to permit patients to select their dentists and allow the option of having their insurance reimbursement sent directly to the dentist of choice, greatly enhancing the patient's access to quality care without increasing costs to the insurer or the patient.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"431:10A-   Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured, regardless of whether the provider is a nonparticipating provider with the insurer.

(c) Nothing is this section shall be construed to affect any other contract provision between an insurer and a dentist, including any differential in reimbursement between participating and nonparticipating providers.

(d) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

"432:1-   Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured, regardless of whether the provider is a nonparticipating provider with the insurer.

(c) Nothing is this section shall be construed to affect any other contract provision between an insurer and a dentist, including any differential in reimbursement between participating and nonparticipating providers.

(d) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432D-   Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider for dental services provided to the insured. The insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Nothing is this section shall be construed to affect any other contract provision between an insurer and a dentist, including any differential in reimbursement between participating and nonparticipating providers.

(d) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insureds.

"Provider" means a dentist licensed to practice in Hawaii under chapter 488."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.

INTRODUCED BY:

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