Department of Insurance reports no denials under 2021 craniofacial law but notes four prosthodontist disputes

The Department of Insurance told the Senate Insurance & Commerce Committee it has received no complaints that insured patients were denied craniofacial services after review by an approved cleft craniofacial team under Act 955 of 2021.

Al McLean, State Insurance Commissioner, said the department prepared a composite report summarizing activity associated with the 2021 law. “Since that law became effective, the department has received no complaints related to the operation and interpretation of the law,” McLean said. He said four complaints were lodged about whether services performed by a prosthodontist should be categorized as medical or dental, and those complaints had not followed the team review steps outlined in the statute.

McLean described the change made by Act 955: the law requires a nationally approved cleft craniofacial team to evaluate persons with craniofacial abnormalities to determine medical necessity and coordinate a treatment plan.

Senator Urban asked whether the four prosthodontist complaints had been part of the team review process; McLean said they had not, and therefore the department received them as independent claims. Senator Irvin, sponsor of the original bill, asked to work with department staff on revising the reporting mechanism and indicated she would provide suggested draft language.

McLean offered to provide the committee membership with the department’s annual insurance report to bring new members up to date on prior reporting. The department did not recommend any immediate statutory changes during the hearing and asked the committee whether it wanted biannual reports going forward.

No votes on statutory changes were taken during the presentation; the department will coordinate with Senator Irvin on possible reporting amendments.