New Florida law amends dental insurance claims process

Under new legislation authorized Friday, dental insurers will be required to clarify covered services, disclose fees for electronic payments and limit retroactive denials of previously authorized payments.

government. Ron DeSantis Legislation was signed into law Friday to reform Florida's dental insurance claims process.

This measure (Senate Bill 892) updates the definition of covered services in dental insurance contracts. If an insurance company, health maintenance organization (HMO), or prepaid limited health services organization (PLHSO) denies services because contract limits have been reached, the procedure will now be considered not covered.

The bill also prohibits insurance companies from restricting the use of credit cards to pay dental claims. Insurers, HMOs and PLHSOs are now required to disclose any fees associated with electronic funds transfers (EFT) to dentists before processing payments.

Dentists must also provide written consent for payment by electronic funds transfer, including a virtual credit card, via email with an electronic signature or by checking a consent box. The law further prohibits charging fees for Automated Clearing House (ACH) transfers unless the dentist agrees.

The bill also prohibits insurance companies from denying payment for procedures they previously authorized except under certain conditions. These situations include reaching benefit limits, inadequate documentation, changes in patient condition, or fraudulent claims.

“This legislation will address a critical issue affecting too many Florida patients – denial of coverage for dental treatment services previously authorized by dental plans,” said. PhD. beatrice terrypresident of the Florida Dental Association. “This new law will help ensure patients receive the dental benefits they pay for.”

The law largely shifts responsibility to insurance companies to ensure that they cannot retroactively deny payment once a dental procedure is authorized. The Florida Office of Insurance Regulation (OIR) and the Agency for Health Care Administration (AHCA) will oversee implementation of these reforms. OIR will oversee insurance company licensing, rate approval, policy forms and compliance, while AHCA will oversee the quality of care provided by HMOs.

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