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STATE OF OKLAHOMA
1st Session of the 60th Legislature (2025)
HOUSE BILL 2056 By: Stinson
AS INTRODUCED
An Act relating to dental insurance claims; amending
36 O.S. 2021, Section 7301, which relates to dental
plans; modifying definition; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 36 O.S. 2021, Section 7301, is
amended to read as follows:
Section 7301. A. No contract between a dental plan of a health
benefit plan and a dentist for the provision of services to patients
may require that a dentist provide services to its subscribers at a
fee set by the health benefit plan unless the services are covered
services under the applicable subscriber agreement.
B. As used in this section:
1. "Covered services" means services reimbursable reimbursed
under the applicable subscriber agreement, subject notwithstanding,
and without regard to the contractual limitations on subscriber
benefits as may apply, including, for example, deductibles, waiting
period or frequency limitations;
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2. "Dental plan" means and shall include any policy of
insurance which is issued by a health benefit plan which provides
for coverage of dental services not in connection with a medical
plan; and
3. "Health benefit plan" means any plan or arrangement as
defined in subsection C of Section 6060.4 of this title or any
dental service corporation authorized pursuant to Section 2671 of
this title.
C. A health benefit plan or dental plan shall establish and
maintain appeal procedures for any claim by a dentist or a
subscriber that is denied based on lack of medical necessity. Any
such denial shall be based upon a determination by a dentist who
holds a nonrestricted license in the United States. Any written
communication to a dentist that includes or pertains to a denial of
benefits for all or part of a claim on the basis of a lack of
medical necessity shall include the identifier and license number
together with state of issuance, and a contact telephone number of
the licensed dentist making the adverse determination. The dentist
who reviewed the claim shall only be contacted at the telephone
number provided in the written communication about the denial during
business hours.
SECTION 2. This act shall become effective November 1, 2025.
60-1-11719 TJ 01/12/25was