Plain English Breakdown
The official summary states that reimbursement is not required by this act for a specified reason, but does not define what that reason is.
AB-371: New Rules for Dental Coverage and Appointments
This law requires health plans to pay out-of-network dentists directly if a patient signs an assignment form, shortens the time allowed to schedule dental appointments, and sets new rules for how close dentists must be located.
What This Bill Does
- Requires health care service plans or insurers that pay contracting providers directly to also pay noncontracting (out-of-network) providers directly if a written assignment of benefits form is submitted by the patient.
- Shortens appointment wait times for specified plans and insurers offering dental coverage: urgent appointments within 48 hours, nonurgent within 18 business days, and preventive care within 20 business days.
- Requires dentists to be available within 15 miles or 30 minutes from a patient's home or workplace.
- Requires plans and insurers to report comprehensive information about their dental provider networks, including self-insured networks.
- Orders the Department of Managed Health Care or the Department of Insurance to review the adequacy of entire dental provider networks.
Who It Names or Affects
- Health care service plans that offer dental coverage
- Health insurers that sell policies with dental benefits
- Dental providers, including those who do not have contracts with insurance companies (noncontracting)
- Patients enrolled in health plans or insured under policies
Terms To Know
- Assignment of Benefits
- A written form signed by a patient that allows an out-of-network dentist to be paid directly by the insurance plan.
- Noncontracting Provider
- A dentist who does not have a formal agreement with a specific health plan or insurer.
- Network Adequacy
- The standard that ensures there are enough dentists in an area to meet patient needs for time and distance, which regulators must review.
Limits and Unknowns
- The bill does not state a specific effective date.
- Specific exceptions regarding reimbursement amounts ('except as specified') are mentioned but details are not provided in the summary text.
- Details on how 'specified reason' exempts local agencies from reimbursement costs are not included.