Bill would add dental claims to Nevada’s external review process for denied benefits

Assemblymember Tracy Brown‑May presented AB202 to the Assembly Commerce and Labor Committee, saying the bill would add dental services to Nevada’s existing external review process for adverse determinations.

‘‘Dental patients currently have no recourse or access to an independent review following the denial of a dental claim,’’ said Assemblymember Tracy Brown‑May, outlining the bill’s intent to allow independent review similar to the process already available for medical claims. The sponsor said the Nevada Office of Consumer Health Assistance (created in 1999) and the state’s external review process for medical claims (added in 2023) provide the model for adding dentistry.

What the bill would do: Paul Klein, speaking for the Nevada Dental Association, said AB202 would amend NRS 695G.241 to include dentists in the definition of a clinical peer, allow dentists to submit written certifications in support of covered services, and permit independent review organizations to consider documentary evidence and treating dentist recommendations when reviewing dental coverage denials. ‘‘Section 3 is the most important. This is the intent of the bill ultimately . . . it expands the rules for managing complaints and external reviews to include insurance policies that cover dental services,’’ Klein told the committee.

Support and concerns: Dr. Amy Abittan, vice president of the Nevada Dental Association and a practicing dentist in Reno, said many denials arrive after treatment is already rendered and that patients should not bear the ultimate financial burden when insurers deny coverage: ‘‘. . .if the ultimate thing is denial, that lands squarely on the patients who have a right to coverage for their medical care from their insurers.’’

Delta Dental (neutral) representative Helen Foley said dental insurance differs from medical insurance and asked for time to provide specific operational information from insurers’ grievance and appeals departments. ‘‘When you talk about a decision here that people don't agree with when you're talking about a physician, it might be tens of thousands of dollars . . . when you're talking about a dental situation, most of them are in the hundreds of dollars,’’ Foley said, urging that rules reflect the different scale and workflows of dental claims.

Procedure and next steps: Sponsor testimony described the external review pathway: after an insurer’s final adverse determination, the patient or provider may seek external review through the Office of Consumer Health Assistance. The outside reviewer evaluates medical necessity and related documentation. The sponsor and dental association representatives said the change would align dental practitioners’ ability to support patients in seeking review with the process available to physicians for medical claims.

Ending: Committee members asked few questions during the hearing; the bill was presented, received supportive testimony from dentists and a neutral statement from an insurer, and the hearing was closed without a committee vote recorded in the transcript.