Requires insurers to pay nonparticipating dentists directly, if the insured assigns those rights.

A BILL FOR AN ACT

SECTION 1. The legislature finds that access to affordability to proper dental services is a continuing problem in this State. The lack of good dental care can lead to other more serious health problems, ultimately resulting in higher medical cost and deteriorating health conditions. While access is not a problem unique to Hawaii, it is imperative that solutions be adopted and implemented in order to prevent further decline.

One of the ways to improve access to dental care is to give patients the option of going to their practitioner of choice, the dentist that they know and trust. This is not currently possible if that dentist is not a participant in the patient's health insurance plan. Often, under such circumstances, the patient would have to pay the dentist first and wait to receive reimbursement from the insurer. In most cases, the reimbursement is less than the amount that would have been paid if the dentist were a participating dentist.

The situation becomes even more critical when a patient has to be seen by a specialist, especially in an emergency. For example, a patient needs to have a root canal and is referred to a specialist but is limited to seeing only a specialist who is a participant in that patient's health insurance. That requirement can result in delays, additional pain and discomfort, and increased risk to patient.

The legislature finds that permitting dental patients to choose their dentist by giving them the option to have their insurance reimbursement sent directly to the dentist of choice will greatly enhance the patient's access to quality care without increasing cost to the insurer or the patient.

SECTION 2. Chapter 431:10A, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§431:10A-   Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Nothing in this section shall be construed to limit any insurer from determining the scope of its benefits, services, or any other terms contained in the insurer's contract except as provided in this section.

(d) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insured.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 3. Chapter 432:1, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432:1-   Dental services; reimbursement. (a) An insured may assign reimbursement for dental services directly to the provider of services.

(b) Upon notification by the insured, the insurer shall reimburse the provider regardless of whether the provider is a participating provider with the insurer.

(c) Nothing in this section shall be construed to limit any insurer from determining the scope of its benefits, services, or any other terms contained in the insurer's contract except as provided in this section.

(d) As used in this section:

"Participating provider" means a provider that contracts with an insurer to provide services to insured.

"Provider" means a dentist licensed to practice in Hawaii under chapter 448."

SECTION 4. New statutory material is underscored.

SECTION 5. This Act shall take effect upon its approval.