Senate Human Services committee restores consumer protection language to dental bill, adopts amendment

The Senate Human Services Committee on an undisclosed date adopted an amendment to Senate Bill 2377 that restores language to prevent preferred provider arrangements from blocking insured people from obtaining or privately paying for covered dental services after annual, lifetime or frequency limits are met, and then passed the bill as amended.

Committee members said the change responds to recurring reports that patients are prevented from paying a provider directly for services the insurer refuses because the patient has exhausted plan frequency or lifetime limits. Rebecca Fricke, executive director of PERS, and dental and insurance stakeholders described the amendment and how it differs from earlier language under consideration.

The amendment adopted by the committee reads in part: “a preferred provider arrangement may not restrict a covered person from receiving or paying for covered services as described in this section for additional dental care services the covered person’s network plan denied due to annual, lifetime or frequency limitations being met.” The amendment also adds the words “and paying for” in subsection 3 (compared with the prior draft) and restores lines 8–10 of the original bill text that committee members and department staff said are necessary consumer protections. Crystal Bartuska of the North Dakota Insurance Department said the department prefers the restored language and recommended changing one term in the draft from “disallow” to “deny” and changing a conjunction from “or” to “and” at a specified line to match department code conventions.

Crystal Bartuska, North Dakota Insurance Department, told the committee, “that 01/2002 is an absolute no go. So yes, 01/2001, the 8, 9, and 10 removing that strikeout does provide that protection to the consumer.” She also recommended replacing the word “disallow” with “deny” to align with the department’s terminology and changing a conjunction on line 18 from “or” to “and.”

William Sherwin with the North Dakota Dental Association said dentists and the department largely want the same outcome: protection for covered services that are denied because frequency or lifetime limits were reached, but not to inadvertently strip other consumer protections. Sherwin described the difference between covered services denied for reasons such as frequency limits and noncovered services, and urged working with department language that preserves protections for covered-but-denied services.

Committee members moved and seconded the amendment. The roll call for the amendment recorded Senators Lee, Weston, Rohrs, Van Osteen and Clemens voting aye; other members were recorded as not voting on that roll-call, producing a recorded result summarized in the committee as “5-0-1” in favor of the amendment. After a short additional procedural exchange to confirm subsection wording, Senator Rohrs moved the amended bill and Senator Weston seconded; the committee again recorded the passage of the bill as amended with the same 5-0-1 result.

During discussion, departmental staff and the dental association emphasized that the statute creating the definition of “covered services” (described in committee discussion as originating in 2011) already allows certain services — such as a third cleaning that is medically necessary — to be treated as covered and that provider contracts cannot eliminate medical necessity protections. Bartuska and Sherwin both urged that complaints about improper contract language be routed to the insurance department for enforcement when appropriate.

The committee requested the final amendment be circulated to the clerk and confirmed the bill file would reflect the restored text and the narrow additional wording (“and paying for”) the committee added. No fiscal note or broader policy changes were debated in detail at the time of the vote.

The committee closed the item after the final vote and moved on to other agenda items.