Dental insurance-payment for services.

23LSO-0516
2023
STATE OF WYOMING
23LSO-0516
Numbered
2.0

SENATE FILE NO. SF0115

Dental insurance-payment for services.

Sponsored by: Senator(s) Cooper, Dockstader, Landen and Nethercott and Representative(s) Walters

A BILL

for

AN ACT relating to the insurance code; providing for dentists to bill and collect payment from insureds for services performed as specified; prohibiting bundling of dental procedures for billing purposes; prohibiting downcoding of dental procedures for billing purposes; providing definitions; making conforming amendments; specifying applicability; and providing for an effective date.

Be It Enacted by the Legislature of the State of Wyoming:

Section 1.

W.S. 26
‑
22
‑
505(a), (b), by creating a new subsection (c) and by renumbering (c) as (d) is amended to read:

26
‑
22
‑
505.

Dental insurance; limitation on fee schedules for covered and noncovered services; billing for services; definition; applicability.

(a)

No person
,

or
entity
or insurer
contracting with dentists to provide coverage or reimbursement for dental services shall require a dentist to provide services at a fee set by the contract, a policy or a certificate unless the services are covered services by the terms of the contract, policy or certificate.

(b)

For purposes of this section
:
,

(i)

"Bundling" means the practice of combining separate dental procedures into one (1) procedure for billing purposes;

(ii)

"C
overed services" means services reimbursable under the contract, policy or certificate, subject to customary contractual limitations on benefits including such items as deductibles, waiting periods, frequency limitations or charges over the benefit maximum
;

(iii)

"Downcoding" means the adjustment of a claim for a dental procedure submitted to an insurer to a less complex or lower cost procedure
.

(c)

No person, entity or insurer contracting with dentists to provide coverage or reimbursement for dental services under the terms of a contract, a policy or a certificate shall:

(i)

Prohibit a dentist from billing and collecting payment from an insured for a service the dentist performs that may not be a covered service by the contract, policy or certificate, if the dentist:

(A)

Notifies the insured that the dentist may not receive full reimbursement or payment from the contracting person, entity or insurer;

(B)

Informs the insured that the insured is responsible for payment of the service or any remaining balance after all insurance payments;

(C)

Obtains the insured's written consent to perform the service; and

(D)

Provides a copy of the insured's written consent to perform the service to the contracting person,

entity or insurer upon request.

(ii)

Use bundling in a manner where a procedure that normally would be billed to the insured would not be billed to the insured unless, under generally accepted medical and dental guidelines, the procedure may be provided in conjunction with another procedure;

(iii)

Use downcoding in a manner that prevents a dentist from billing for the actual service performed and collecting payment from the insurer, the insured or both.

(c)
(d)

This section shall apply to contracts, policies or certificates issued, renewed, delivered or issued for delivery in this state on or after July 1, 2011.

Section 2.

This act shall apply to all contracts, policies or certificates issued, renewed or delivered on or after July 1, 2023.

Section 3
.

This act is effective July 1, 2023
.

(END)

1
SF0115