Kansas House Bill HB2247

Kansas 2025-2026 Regular Session

• Introduced: 2/4/25
• Refer: 2/4/25

Caption

Prohibiting certain terms in a contract between a health insurer and a dentist and requiring that reviews, audits or investigations of healthcare providers be completed within six months.

Summary

HB 2247 would regulate certain interactions between dental providers and insurers in Kansas. First, it requires nonprofit dental service corporations to complete any review, audit, or investigation that could lead to recoupment or setoff of previously paid claims within six months after the claims were initially paid, while preserving exceptions for fraud, known patterns of inappropriate billing, coordination of benefits, and situations governed by federal law. The bill also limits how dental benefit plans and utilization review entities may use prior authorization. If a dentist receives prior authorization for a procedure, the insurer generally could not later deny the claim for that procedure unless one of several specified exceptions applies, such as later-reached benefit limits, inadequate documentation, changed patient condition, or new procedures that alter medical necessity. In addition, the bill amends existing Kansas law governing contracts between insurers and dentists to bar provisions that cap fees for non-covered services or prevent dentists from billing patients when a service is denied but remains dentally necessary.

Impact

The bill would amend and replace K.S.A. 40-2,185, expanding protections for dentists in contracts with health insurers and dental benefit plans. It would restrict insurer contract terms, preserve dentists' ability to bill for non-covered but dentally necessary services, and create a six-month deadline for certain post-payment claim reviews by nonprofit dental service corporations. The measure primarily affects dental insurers, dental service corporations, utilization review entities, dentists, and patients receiving dental care in Kansas.

Sentiment

The available context suggests generally favorable treatment of the bill, as it was requested by the Kansas Dental Association and referred to the House Committee on Health and Human Services. The bill text reflects a provider-protection approach that is likely intended to address insurer practices seen as burdensome or unpredictable for dentists. No recorded votes or committee transcripts are available here, so there is no direct evidence of opposition or amendment debate in the provided materials.

Contention

The main points of potential contention are the limits placed on insurers' ability to recoup payments after claim review and the restrictions on denying claims after prior authorization has been issued. Insurers and utilization review entities may object that the bill reduces flexibility to correct billing errors, manage utilization, or respond to later-discovered information, while dentists and their advocates are likely to support the bill as a safeguard against retroactive denials and delayed audits. The exceptions for fraud, inappropriate billing, coordination of benefits, and federal law appear designed to address some insurer concerns.