Bill > HB1535

This bill aims to reform the dental insurance system in Washington State by addressing perceived inequities and protecting patient interests. The legislation introduces several key provisions designed to improve transparency, fairness, and patient choice in dental insurance. Specifically, the bill requires limited health care service contractors offering dental coverage to permit treating dentists, in consultation with patients, to make decisions about dental services without undue interference from insurance companies. It prohibits denying coverage based on independent insurance diagnoses or for procedures performed on the same day. The bill mandates that at least 85 percent of premium dollars must be spent directly on patient care, and introduces requirements for insurers to submit detailed financial information about their dental plans. Additionally, the legislation provides mechanisms for patients to challenge claim denials and requires insurers to offer refunds if their dental loss ratio falls below 85 percent. The bill also restricts how insurers can modify reimbursement rates for dentists and ensures that non-contracting providers are reimbursed at the same rate as contracting providers. By implementing these reforms, the legislature seeks to create a more patient-centered dental insurance system that prioritizes care over corporate profits and provides greater transparency and protection for Washington residents.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=1535&Year=2025&Initiative=false