Dental plans generally may not force dentists to accept a particular fee or only one payment method, and they must give notice and instructions when changing payment methods.
§1157. Dental reimbursement or payments A. As used in this Section, the following definitions shall apply: (1) "Covered person" means any subscriber, enrollee, member, or participant in a dental plan, or his dependent, for whom benefits are payable when that person receives dental healthcare services rendered or authorized by a licensed dentist. (2) "Covered service" means any dental service rendered or authorized by a licensed dentist on a covered person for which a dental service contractor or insurer is required to pay benefits to the dentist under a contractual agreement with such dentist. Such a service includes any service on which reimbursement is limited by a deductible, copayment, coinsurance, waiting period, annual maximum, or frequency limitation. (3) "Credit card payment" means a type of electronic funds transfer in which a dental plan or its contracted vendor issues a single-use series of numbers associated with the payment of healthcare services performed by a dentist chargeable for a predetermined dollar amount, requiring the dentist to be responsible for processing the payment by a credit card terminal or internet portal. "Credit card payment" includes a virtual or online credit card payment, in which no physical credit card is presented to the healthcare provider and the single-use credit card expires upon payment processing. (4) "Dental plan" means any insurance policy, benefit plan, or dental service contract providing for the payment of benefits for dental healthcare services. (5) "Electronic funds transfer" means an electronic funds transfer through the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, standard automated clearinghouse network. B. No dental plan that is delivered, renewed, issued for delivery, or otherwise contracted for in this state may require that a dentist provide dental health care services to a covered person at a particular fee unless such services are covered services for which benefits are paid under a contract with such dentist. C. Nothing in this Section shall prohibit a dental service contractor or insurer from offering a dentist optional agreements for participation in a dental plan in which a dentist may choose to participate either with or without a provision to provide discounts to covered persons for non-covered services provided that all of the following apply: (1) No dental service contractor or insurer may restrict in any manner the choice of any dentist to participate in the plan with or without an optional agreement providing for discounts on non-covered services except that the option for any dentist choosing to participate in the plan under such an optional agreement to cease providing such discounts under said optional agreement but still continue participating in the plan may be limited to each time said optional agreement is up for renewal. (2) The provision for discounts on non-covered services shall be the only material difference between agreements entered into with a dentist who accepts such an optional agreement and those with a dentist who accepts a contract without said optional agreement. D.(1) No dental plan that is delivered, renewed, issued for delivery, or otherwise contracted for in this state shall restrict methods of payment from the dental plan to the dentist for the purpose of making a credit card payment the only means of payment acceptable for healthcare services provided by the dentist to an insured. (2) If initiating or changing payments to a dentist using electronic funds transfers or credit card payments, a dental plan shall do both of the following: (a) Notify the dentist if any fees are associated with a particular payment method. (b) Advise the dentist of all the available methods of payment and provide clear instructions to the dentist on how to select an alternative payment method. (3) The provisions of this Subsection shall not be waived by contract, and any contractual clause in conflict with the provisions of this Subsection or that purports to waive any requirements of this Subsection is void. Acts 2010, No. 940, §1, eff. Jan. 1, 2011; Acts 2019, No. 49, §1.