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Dentists and insurance department discuss in‑network denials and billing language in proposed dental amendments
Summary
The North Dakota Dental Association urged changes to in‑network contract language to prevent insurers from both denying coverage and preventing providers from collecting payment; the Insurance Department asked for more time to study balance-billing risks and enforcement implications.
Representatives of the North Dakota Dental Association and the state Insurance Department discussed proposed amendments Oct. 12 to bills addressing insurer–provider contract language and a dentist’s ability to collect payment when an insurer denies payment.
William Sherwin of the North Dakota Dental Association told the Senate Human Services Committee that carriers have been denying coverage and also using contract provisions that prevent dentists from billing patients for services the carrier declines to cover. Sherwin urged language that would prevent an in‑network preferred provider arrangement from both denying a covered service and contractually prohibiting the dental provider from collecting payment from the patient.
Sherwin described the problem using typical dental examples: differences between a bridge and an implant, or materials choices, and frequency limits like a third cleaning that insurers will deny under annual or lifetime limits. He said the association wants to preserve a patient's ability to elect and pay for care when a carrier will not reimburse it, while also recognizing the committee must guard against abusive billing.
Crystal Bartuska of the North Dakota Insurance Department told the committee she had just received the draft amendments and needed time to review them with staff. Bartuska said the department’s priority is consumer protection and that she was concerned the amendment could be read to authorize dentists to obtain higher payment or balance‑bill consumers beyond in‑network schedules; she asked for time to work with the dental association to ensure the bill does not produce unintended consumer harms.
Sherwin said the dental association supports consumer protections such as the state’s balance‑billing statute (cited by committee staff as a prior measure in 21‑35) but still wants guardrails so a patient who chooses additional or elective treatment may arrange payment with their dentist when the carrier will not pay. The committee and staff agreed to confer further with the Insurance Department on precise wording to ensure the amendment preserves patient choice without enabling overbilling.
No vote was taken on the dental amendment during the hearing; the committee asked the Insurance Department and the dental association to confer and return with a clarified amendment.
