Health Insurance and Dental Plan Organizations - Dentists - Assignment of Benefits and Reimbursement of Nonpreferred Providers
Summary
SB813 expands Maryland’s insurance assignment-of-benefits rules to explicitly cover dentists and dental plan organizations. The bill prohibits insurers and dental plan organizations from blocking an insured or enrollee from assigning benefits to a dentist, and it requires direct reimbursement to nonpreferred dentists when a valid assignment exists. It also requires nonpreferred dentists to give patients advance disclosures before treatment, including notice that the dentist is out of network, possible charges for noncovered services and balance billing, an estimate of costs, payment terms, and any interest charges.
The bill also directs the Maryland Insurance Commissioner to develop disclosure forms to implement these requirements. If no assignment is provided, insurers and dental plan organizations must send payment information to the patient that identifies the claim, the amount paid, the patient’s responsibility, and instructions to forward the payment to the provider. The law includes exceptions allowing refusal to directly reimburse when notice arrives too late, payment was already made to the patient by mistake, the patient withdrew the assignment, or the patient already paid the dentist in full. The act takes effect January 1, 2027.
Impact
SB813 amends the Insurance Article to add dentists to existing assignment-of-benefits protections that previously applied to physicians and other providers, and it creates a new section governing dental plan organizations. It also broadens the definition of “similarly licensed provider” to include dentists and dental groups for purposes of the insurance subtitle. The practical effect is to strengthen payment rights for nonpreferred dentists while imposing patient-notice and documentation requirements on dentists seeking assignments and on insurers/dental plans processing claims.
Sentiment
The recorded floor votes were unanimous in each chamber, with no recorded opposition, suggesting broad bipartisan support for the bill. The bill’s structure also indicates a policy consensus around protecting provider payment rights while preserving consumer disclosure and limiting direct reimbursement in narrow administrative or payment-error situations. No committee transcript was provided, so the available record shows support but not detailed debate.
Contention
The main policy tension in SB813 is between protecting dentists’ ability to receive direct payment through assignments of benefits and preserving insurer/dental plan administrative control over claims payment. Potential points of concern include balance billing, the adequacy of required disclosures to patients, and whether the exceptions for late notice, prior payment, withdrawal of assignment, or full payment at service are sufficient to prevent duplicate payments or disputes. The bill appears to address these concerns by requiring advance notice from nonpreferred dentists and standardized disclosure forms from the Commissioner.