SENATE DOCKET, NO. 1345        FILED ON: 1/19/2023

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 697

The Commonwealth of Massachusetts

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PRESENTED BY:

Patrick M. O'Connor

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To the Honorable Senate and House of Representatives of the Commonwealth of Massachusetts in General
Court assembled:

The undersigned legislators and/or citizens respectfully petition for the adoption of the accompanying bill:

An Act relative to dental insurance consumer protections.

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PETITION OF:

SENATE DOCKET, NO. 1345        FILED ON: 1/19/2023

SENATE  .  .  .  .  .  .  .  .  .  .  .  .  .  .  No. 697

The Commonwealth of Massachusetts

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In the One Hundred and Ninety-Third General Court
(2023-2024)

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An Act relative to dental insurance consumer protections.

Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
 

Chapter 176X of the General Laws, as appearing in the 2020 Official Edition, are hereby amended by adding the following chapter:- 

Chapter 176Y

SECTION 1.  DISCLOSURE OF BENEFIT TERMS. 

(a)  An employee benefit plan or health insurance policy shall: (1)  if applicable, disclose that the benefit for dental care services offered is limited to the least costly treatment; and  (2)  specify in dollars and cents the amount of the  payment or reimbursement to be provided for dental care services or  define AND explain the standard on which payment of benefits or  reimbursement for the cost of dental care services is based, such  as:  (A)  "usual and customary" fees;  (B)  "reasonable and customary fees;  (C)  "usual, customary, and reasonable" fees; or (D)  preset fee schedule or (E) words of similar meaning.       

(b)  A person or entity who provides or issues an employee benefit plan or health insurance policy or the employer or employee organization, if applicable, shall establish an Internet website to provide resources and accurate information to dentists, insureds, participants, employees, and members, including the standard on which reimbursement is based.      

(c)  An employee benefit plan or health insurance policy shall make accessible on the Internet website established under subsection (b) information about the plan or policy sufficient for patients and dentists to determine the type of dental care services covered by the plan or policy and the amount of the payment or  reimbursement available for those services under the plan or  policy. Access to the Internet website must be at no charge to patients under the plan or policy and dentists providing dental care services to the patients whether in network or out of network.       

SECTION 2. 

(a)  The employee benefit plan or health insurance policy  shall:  (1)  provide:  (A) that payment or reimbursement for a  noncontracting provider dentist shall be the same or greater as payment or  reimbursement for a contracting provider dentist;  (B)  that the party to or beneficiary of the  plan or policy may assign the right to payment or reimbursement to  the dentist who provides the dental care services; and (C)  one or more methods of payment or  reimbursement that provide the dentist 100 percent of the contracted amount of the payment or reimbursement and that do not  require the dentist to incur a fee to access the payment or  reimbursement; and (2)  disclose on the Internet website required under and on request of a dentist or a party to or  beneficiary of the plan or policy the fees, if any, associated with  the methods of payment or reimbursement available under the plan or  policy.       

SECTION 3. 

(a)  An employee benefit plan or health insurance policy may  not:  (1)  interfere with or prevent an individual who is a  party to or beneficiary of the plan or policy from selecting a  dentist of the individual's choice to provide a dental care service  the plan or policy offers if the dentist selected is licensed in  this state to provide the service;  (2)  deny a dentist the right to participate as a  contracting provider under the plan or policy if the dentist is  licensed to provide the dental care services the plan or policy  offers;  (3)  authorize a person to regulate, interfere with, or  intervene in the provision of dental care services a dentist  provides a patient, including diagnosis, if the dentist practices  within the scope of the dentist's license;  (4)  require a dentist to make or obtain a dental x-ray  or other diagnostic aid in providing dental care services; or (5)  deduct the amount of an overpayment of a claim from  a payment or reimbursement of another claim unless both claims were  for dental services provided to the same patient by the same  dentist. 

(b)  This section does not prohibit the predetermination of benefits for dental care expenses before the attending dentist provides treatment.  An employee benefit plan or health insurance policy that provides a written predetermination of benefits to a dentist with respect to a dental care service for a patient that  includes a specific benefit payment or reimbursement amount may not  pay or reimburse the dentist for providing that service to the  patient in an amount that is less than the amount set forth in the  predetermination.