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May 17, 2013 at 10:18 AM
The Iowa Supreme Court has ruled 7-0 to put limits on how regulators, insurers and consumers can interpret a state law that lets dental plans restrict balance billing.
The law, Iowa Code Section 514C.3B, does let dental plans use provider contracts to prohibit balance billing when a plan pays at least part of the cost of the care, the court says.
But, if a plan member pays the full cost of a procedure, then the dental plan cannot impose any balance-billing restrictions on bills for that procedure, the court says.
Iowa Supreme Court Justice Edward Mansfield wrote the opinion explaining the court’s decision in the case, Iowa Dental vs. Iowa Insurance Division et al. (Case Number 12-1280).
The ruling could have an indirect effect on interpretation of dental plan balance-billing cases in other states, because Mansfield analyzes the dental plan balance-billing laws passed in nine states in 2009 and 2010.
“Balance billing” happens when a dentist, physician or other care provider bills the patient for the difference between the maximum fee that an insurer allows and what the provider wants to charge.
In 2010, Iowa lawmakers adopted the Section 514C.3B law, which states that a dental insurer or dental plan administrator can include limits on balance billing for covered services in provider contracts.
The Iowa commissioner ruled that plans can apply balance-billing restrictions when services that could be covered are not simply because of plan design features.
