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November 29, 2010 at 07:00 PM
Members of the National Conference of Insurance Legislators (NCOIL) have approved a model act that could limit dental plans’ ability to impose balance-billing restrictions.
State lawmakers adopted the Model Act Banning Fee Schedules for Uncovered Dental Services recently in Austin, Texas, at NCOIL’s annual meeting.
“Balance billing” occurs when a care provider receives reimbursement from a patient’s insurer, then bills the patient directly for the difference between the amount charged and the amount the insurer has paid.
A medical or dental insurer often will prohibit a provider in its network from balance billing in-network patients who receive covered services.
In the network contract, an insurer and provider may agree that the amount the insurer pays — together with any co-payments, coinsurance payments or deductibles required of the patient – will fulfill the patient’s obligations to the provider.
The NCOIL model act distinguishes between balance-billing provisions that cover the services that a dental plan covers in-network and the services the dental plan does not cover, whether or not the patient is seeing an in-network dentist.
The model would let dental plans continue to prohibit balance billing for in-network services, but it would ban balance-billing restrictions on uncovered services.
