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Bill would bar insurers from contract clauses that block dentists from charging patients for denied services
Summary
Senate Bill 2,377 (heard as related item) would prevent preferred-provider arrangements from contractually prohibiting dentists from collecting payment from patients for services insurers deny; proponents said the change protects the doctor-patient relationship and patient choice when carriers use frequency, material or coverage limits.
Senate Bill 2,377 would prohibit preferred-provider arrangements from restricting a covered personthe patientfrom receiving additional dental care services that are denied under the planand would prevent carriers from using contract clauses that stop a dentist from collecting payment the patient wishes to make.
William Sherwin of the North Dakota Dental Association told the committee that carriers have inserted "disallow clauses" into contracts that deny certain services (for example, additional cleanings beyond a plans frequency limit, an upgraded filling material, or a root canal the carrier deems noncovered) and then prohibit the dentist from collecting payment from the patient for the selected service. Sherwin characterized those clauses as an end run around the states noncovered-services law and said they limit the dentistpatient treatment choice.
Sherwin explained that, under the proposal, when a service is denied as noncovered the patient would still be able to elect the service and pay the provider under the contractso long as the payment mechanics follow the law. He said the bill preserves the insurers ability to deny coverage but prevents carriers from inserting contractual terms that interfere with the doctorpatient relationship and prevent patients from paying for care they want.
Crystal Bartuska of the Insurance Department described the statutory history: a 2011 change to the noncovered-services language had sought to prevent carriers from setting fees for services they did not reimburse. She said carriers had later used contract language to restrict dentists from collecting for noncovered services, producing the current problem the bill seeks to fix.
Committee members asked for clarity on implementation questions such as whether the patients payment would be the negotiated in-network rate or a full provider-set price when a carrier denies coverage. Sherwin said the current drafting leaves in-network reduced rates in place for covered services that become denied; one amendment under discussion would revert to the providers fee schedule if a carrier refused payment, an issue the committee may parse further.
No committee vote on SB 2,377 was recorded during the hearing. Supporters asked the committee to act to protect patients and local practices from clauses they said deny patient choice and interfere with informed treatment planning.
Ending: Supporters framed the bill as a narrow protection of the doctor-patient relationship; insurers urged careful drafting to avoid unintended pricing consequences for employers and for plans.
