Health Insurance and Dental Plan Organizations - Dentists - Assignment of Benefits and Reimbursement of Nonpreferred Providers
Summary
HB1091 expands Maryland’s existing assignment-of-benefits rules for health insurance to explicitly include dentists, and creates a parallel set of requirements for dental plan organizations. Under the bill, insurers and dental plan organizations may not prohibit an insured or enrollee from assigning benefits to a nonpreferred dentist, and they may not refuse direct reimbursement solely because the provider is a dentist. The bill also requires carriers to send payment information to the patient when no assignment is on file, so the patient knows what was paid, what remains owed, and that the payment should be used to pay the dentist.
The bill adds consumer-protection and disclosure requirements for nonpreferred dentists who seek an assignment of benefits. Before providing services, the dentist must tell the patient that they are nonpreferred, may bill for noncovered services and balance bills, provide an estimate of costs, explain payment terms, and disclose whether interest will be charged. The dentist must also submit a commissioner-developed disclosure form documenting the assignment. The Maryland Insurance Commissioner is directed to create the forms needed to implement these rules, and the act takes effect January 1, 2027.
Impact
HB1091 amends the Insurance Article by revising definitions and assignment-of-benefits provisions in existing law and by adding a new section specifically governing dental plan organizations. It extends protections that already apply to nonpreferred physicians to nonpreferred dentists, while also creating a separate statutory framework for dental coverage and reimbursement. The bill affects insurers, dental plan organizations, dentists, insureds, and enrollees by standardizing how benefit assignments and direct payments must be handled for dental services.
Sentiment
The bill appears to have broad bipartisan support and little visible opposition. It passed the House 125-0 and the Senate 46-0, indicating unanimous approval in both chambers. The absence of committee transcript debate suggests the measure was viewed as a technical consumer-protection and reimbursement clarification rather than a controversial policy change.
Contention
The main policy issue addressed by the bill is whether insurers and dental plan organizations should be required to honor assignments of benefits to nonpreferred dentists and pay those dentists directly. Any potential concern would likely come from carriers or plan organizations about administrative burden, timing of notice, and exceptions when payment has already been made to the patient or the patient has paid the dentist in full. The bill resolves those concerns by allowing refusal of direct reimbursement in limited circumstances, such as late notice, prior payment to the enrollee, withdrawal of the assignment, or full payment at the time of service.