New Florida law amends dental insurance claims process

by | May 20, 2024

Dental insurers will be required to clarify covered services, disclose fees for electronic payments, and restrict retroactive denials of previously authorized payments under new legislation authorized on Friday.

Gov. Ron DeSantis signed legislation on Friday to introduce reforms to Florida’s dental insurance claims process.

The measure, Senate Bill 892, prohibits insurers from limiting dental claim payments to credit cards. Insurers, HMOs, and PLHSOs must now disclose any fees associated with electronic funds transfers (EFT) to dentists before processing payments.

Dentists must additionally provide written consent for EFT payments, including virtual credit cards, given via email with an electronic signature or by checking a consent box. The law further bans fees for automatic clearing house (ACH) transfers unless the dentist has agreed to them.

The bill also prevents insurers from denying payment for procedures they previously authorized, except under specific conditions. These conditions include hitting benefit limits, inadequate documentation, changes in the patient’s condition, or fraudulent claims.

“This legislation will address a key issue that is affecting too many Florida patients – denial of coverage for dental treatment services that had been previously authorized by their dental plan,” said Dr. Beatriz Terry, President of the Florida Dental Association. “This new law will help ensure patients receive the dental benefits they are paying for.”

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


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