Bill > SB813

This bill, effective January 1, 2027, prohibits health insurers and dental plan organizations from preventing insured individuals or enrollees from assigning their benefits to dentists, and from refusing to directly pay dentists who are not part of their preferred network (nonpreferred providers) when benefits are assigned. If a dentist is a nonpreferred provider and seeks an assignment of benefits, they must inform the patient beforehand about their nonpreferred status, potential charges for noncovered services, the possibility of balance billing for covered services, an estimate of costs, payment terms, and any applicable interest. The dentist must also submit a disclosure form to document the assignment of benefits. The bill also clarifies that "similarly licensed provider" includes dentists who perform the same or similar dental services, and requires insurers to provide specific claim and payment information to insureds when a nonpreferred provider is involved, instructing them to use the payment to cover the provider's fees if not already paid in full. Insurers and dental plan organizations can refuse direct reimbursement to nonpreferred providers under certain circumstances, such as if they receive notice of the assignment after payment has already been made to the insured, if the insured withdraws the assignment before payment to the provider, or if the insured paid the provider in full at the time of service.