Certain health insurance and related plans must cover anesthesia and related hospital charges for dental treatment in a hospital when medically required, with stated exemptions.
§1040. Coverage for dental procedures; anesthesia and hospitalization A. Every hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, health and accident insurance policy, or any policy of group, family group, blanket, or association health and accident insurance, a self-insurance plan, health maintenance organization, and preferred provider organization, and the Office of Group Benefits programs, which are delivered or issued for delivery in this state shall provide benefits for anesthesia when rendered in a hospital setting and for associated hospital charges when the mental or physical condition of the insured requires dental treatment to be rendered in a hospital setting. B. An insurer under this Section may require prior authorization for hospitalization for dental care procedures in the same manner that prior authorization is required for hospitalization for other covered medical conditions. For a patient to satisfy the criteria of Subsection A of this Section, a dentist shall consider the Indications for General Anesthesia, as published in the reference manual of the American Academy of Pediatric Dentistry, as utilization standards for determining whether performing dental procedures necessary to treat the particular condition or conditions of the patient under general anesthesia constitutes appropriate treatment. C. The provisions of this Section shall not apply to treatment rendered for temporal mandibular joint (TMJ) disorders. D. An insurer under this Section may restrict coverage to include only procedures performed by: (1) A fully accredited specialist in pediatric dentistry or other dentists fully accredited in a recognized dental specialty for which hospital privileges are granted. (2) A dentist who is certified by virtue of completion of an accredited program of post-graduate hospital training to be granted hospital privileges. (3) A dentist who has not yet satisfied the certification requirements, but has been granted hospital privileges as of January 1, 1998. E. The provisions of this Section shall not apply to limited benefit health insurance policies or contracts authorized to be issued in this state. Acts 1997, No. 1125, §1, eff. Jan. 1, 1998; Acts 1999, No. 1188, §1; Acts 2001, No. 1178, §2, eff. June 29, 2001; Acts 2003, No. 129, §1, eff. May 28, 2003; Redesignated from R.S. 22:228.7 by Acts 2008, No. 415, §1, eff. Jan. 1, 2009; Acts 2010, No. 919, §1, eff. Jan. 1, 2011.