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§27-19-54  Dental insurance assignment of benefits. –

Published: 2015

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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.)