TITLE 27
Insurance
CHAPTER 27-19
Nonprofit Hospital Service Corporations
SECTION 27-19-54
§ 27-19-54 Dental insurance assignment of
benefits.
Every entity providing a contract of insurance subject to this chapter shall
allow, as a provision in a group or individual policy, contract or health
benefit plan for coverage of dental services, any person insured by such entity
to direct, in writing, that benefits from a health benefit plan, policy or
contract, be paid directly to a dental care provider who has not contracted
with the entity to provide dental services to persons covered by the entity but
otherwise meets the credentialing criteria of the entity and has not previously
been terminated by such entity as a participating provider. If written
direction to pay is executed and written notice of the direction to pay is
provided to such entity, the insuring entity shall pay the benefits directly to
the dental care provider. Any efforts to modify the amount of benefits paid
directly to the dental care provider under this section may include a reduction
in benefits paid of no more than five percent (5%) less than the benefits paid
to participating dentists. The entity paying the dentist, pursuant to a
direction to pay duly executed by the subscriber, shall have the right to
review the records of the dentist receiving such payment that relate
exclusively to that particular subscriber/patient to determine that the service
in question was rendered.
History of Section.
(P.L. 2004, ch. 268, § 2; P.L. 2004, ch. 386, § 2.)
