Dental coverage.
Vote required
Majority
Fiscal committee
No
Appropriation
No
Current location
Passed
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Assembly
- Passed Senate
- To Governor
- Became Law
Overview
This bill aims to improve dental coverage for Californians by requiring health care service plans and health insurers to pay noncontracting dental providers directly when they receive services from those providers. It mandates disclosures to patients about out-of-network costs and requires predeterminations or prior authorizations for covered services. The bill also expands the definition of unprofessional conduct for dentists to include failing to provide necessary disclosures when accepting an assignment of benefits. Furthermore, it requires the Department of Managed Health Care and the Department of Insurance to review dental provider networks for adequacy and requires providers to certify the accuracy of network information.
Key provisions
- Requires health plans to pay noncontracting dental providers directly when they receive services.
- Mandates disclosures to patients about out-of-network costs and potential impact on maximums.
- Requires predeterminations or prior authorizations for covered dental services.
- Expands the definition of unprofessional conduct for dentists regarding assignment of benefits.
- Requires dental provider networks to be reviewed for adequacy by the Department of Managed Health Care and the Department of Insurance.
- Requires providers to certify the accuracy of network information.
- Requires noncontracting dental providers to disclose information to patients before accepting an assignment of benefits.
- Requires health plans to notify patients when a provider is paid and the potential impact on out-of-pocket costs.
Bill text
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