Senate File 159 stalls after heated debate over downcoding and bundling rules for dental claims

Senate File 159, which would limit insurer downcoding of dental claims and narrow bundling practices, drew extensive testimony from dentists, carriers and state officials and was not advanced at Tuesday’s Labor, Health & Social Services Committee meeting.

Sponsor Sen. Cindy Jones told the committee the bill would add statutory definitions of downcoding and bundling, require more-detailed explanation-of-benefits (EOB) language when claims are adjusted, and permit dentists to collect fees when patients sign informed, written consent. Jones said the bill’s purpose is to ensure transparency for patients and to preserve the dentist–patient relationship.

Dentists and dental-association representatives testified in support. Dr. Brian Coten, a dentist from Buffalo, said the bill would “put patient's care back into patient's hands and out of the corporate bottom lines.” He and other dentists described frequent coding adjustments by insurers that they said reduce reimbursement and erode the care relationship. Several presenters estimated a large share of claims are subject to downcoding or bundling; one speaker said “close to 75 to 80% of all claims” their office handles are adjusted.

Insurers and Delta Dental testified in opposition or neutral-to-opposed positions. Delta Dental of Wyoming presented data from 2024 showing corrective-coding activity on certain procedures: of roughly 5,800 surgical-extraction submissions, about 1,100 (19.62%) were corrected when clinical notes did not support a surgical-extraction code; crown submissions showed about 3% corrective coding. Delta representatives said those corrections are made after clinical review when documentation does not support the billed code and warned the bill would shift hundreds of thousands of dollars in costs to patients and employer plans. Delta provided estimates (based on its 2024 book of business) that unbundling or permitting balance billing and forbidding corrective coding could shift roughly $900,000 across its business and about $320,000 for the state employee plan in the example provided.

Insurance Commissioner Jeff Rood and state officials said they were neutral and raised implementation concerns. Commissioner Rood said other states that enacted similar language saw more consumer complaints because patients receiving direct bills from dentists sometimes call regulators. He also flagged a term in the bill — "generally accepted practice standards" — as creating potential conflicting interpretations between insurers and providers.

After extended discussion and multiple proposed amendments from insurers and Delta Dental to clarify documentation and scope, no motion was made to move the bill. Committee leadership said the bill would remain on the table; sponsors and stakeholders were urged to keep negotiating technical language.