A BILL TO BE ENTITLED
AN ACT TO PROHIBIT HEALTH BENEFIT PLANS AND INSURERS FROM LIMITING
OR FIXING THE FEE A DENTIST MAY CHARGE PATIENTS FOR SERVICES
UNLESS THE SERVICES ARE COVERED FOR REIMBURSEMENT UNDER THE
PLAN OR INSURER CONTRACT WITH THE DENTIST.
The General Assembly of North Carolina enacts:
§ 58-50-290. Health benefit plans or insurers contracting for provision of dental services; no limitation on fees for noncovered services or on methods of claims payment.
(a) No agreement between an insurer or an entity that writes stand-alone dental insurance and a dentist for the provision of dental services on a preferred or in-network basis to plan members or insurance subscribers in connection with coverage under a stand-alone dental plan, but not in connection with or incidental to coverage under a medical plan or health insurance policy, may require that a dentist provide services at a fee limited or set by the plan or insurer, unless the services are reimbursed as covered services under the contract.
(b) For purposes of this section, "covered services" means a service for which reimbursement is available under an insurer's policy, without regard to contractual limitations by a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative benefit payment, or other limitation.
(c) No agreement between an insurer or another entity contracting for the provision of dental services and a provider of dental services shall contain restrictions on methods of claim payment in which the only acceptable payment method from the insurer or entity to the provider of the dental services is a credit card payment. (2010-138, s. 1; 2019-26, s. 1.)