H.B. 159’s Regulation of Dental Insurance

The experienced dental law attorneys at Nardone Limited follow recent developments in the field of dental law.  To prevent dental insurers, dental benefit plans, and other contracting entities from instituting fee limitations on services not considered to be “covered dental services” for dental insurance plan enrollees, the Ohio General Assembly recently introduced H.B. 159, which aims to regulate the dental insurance industry in Ohio. 

Three Primary Regulations

If adopted, H.B. 159 will regulate the dental insurance industry in three primary ways:

1.  First, unless certain conditions are met, it will outlaw dental insurers, dental benefit plans, and other contracting entities from requiring a dentist to provide services to enrollees of the dental insurance plan at a fee set by or subject to approval by the insurance company.  This particular prohibition would become part of Ohio’s Health Care Contract Law. 

2.  Second, unless specific circumstances are met, the proposed law would make it an unfair or deceptive practice in the insurance industry to set or require the insurer’s approval of fees for dental services that are not considered “covered dental services.” 

3.  Third, the new law would prohibit insurers from offering a health benefit plan that sets fees for dental services that are not “covered dental services” unless certain provisions are met.

These prohibitions cease to apply in cases in which they conflict with ERISA rules.

What This Means for Dentists

This law, if enacted, could greatly affect what a dentist is able to charge for various services.  Insurance companies would not be able to restrict the amount that a dentist is able to charge for services and dentists would not be required to be granted approval by an insurer for fees set for services that are not “covered dental services.”  For dentists, this means greater freedom in setting fees for services.