Dental coverage

The law limits upfront charges patients may face from out-of-network dental providers and requires clear disclosures before they assign insurance payments. It also requires dental plans and insurers to certify that network-adequacy reporting accounts for everyone using the same provider network.

What the law does ​

• Requires dental plans and insurers to directly pay noncontracting dentists and registered dental hygienists in alternative practice for covered out-of-network services when they receive a valid assignment of benefits.
• Requires providers to obtain signed, dated patient consent and give disclosures about out-of-network status, possible lower in-network costs, estimated charges, coverage limits, and the optional and revocable nature of an assignment.
• Bars providers from charging patients before plan payment more than estimated cost sharing or a comparable deposit.
• Makes violations of the provider disclosure, consent-recordkeeping, and upfront-charge rules unprofessional conduct.
• Requires plans and insurers to certify under penalty of perjury that network-adequacy submissions are true and account for all people using the same provider network.

Who it affects ​

• People with dental coverage that includes out-of-network dental services.
• Noncontracting dentists and registered dental hygienists in alternative practice.
• Dental health care service plans, specialized dental plans, health insurers, and specialized dental insurers.