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Louisiana passes bill that protects dentists, patients regarding claim denials

June 27, 2018

By David Burger

Baton Rouge, La. — A new law in Louisiana will prohibit dental carriers from denying any claim for a procedure where the insurer has issued a prior authorization.

HB 429, developed by the Louisiana Dental Association, also prohibits dental carriers from denying or recouping a claim due to loss of coverage or patient ineligibility if the carrier had inaccurately confirmed coverage and eligibility but possessed sufficient information at that time to indicate the patient actually was not covered or was no longer eligible.

Gov. John Bel Edwards signed the bill, which was passed unanimously in the state House and Senate May 15. The law will become effective Jan. 1, 2019.

"In simple terms, it clears up much of the confusion between dentists, patients and insurance companies that in the end, significantly impedes dentists' ability to get properly paid for their services," said Ward Blackwell, LDA executive director, in an ADA News interview.

Mr. Blackwell continued: "Moreover, it will eliminate instances of insurers issuing pre-treatment estimates, pre-determinations and similar documents that offer no assurance of a subsequent claim being paid in lieu of a prior authorization."

He added that under the law, a dental benefits company can't recoup a paid claim if the company had confirmed to the dentist a patient's coverage/eligibility and later found the patient was not covered/eligible, but had sufficient information available indicating that the patient was no longer covered or was ineligible for coverage.

The legislation was drafted after LDA past immediate President Dr. David Hildebrandt heard from member dentists numerous examples of issues they'd encountered in their dealings with dental benefits companies, Mr. Blackwell said. "Numerous dentists indicated that they had received prior authorizations — or similar documents issued in response to requests for prior authorizations  — and subsequently had the claims for those procedures denied. This was clearly one of the more significant issues members were facing, both in terms of aggravation and financial impact.

"LDA staff and lobbyists determined that legislation was likely the best approach to address the problems of insurance companies issuing prior authorization and confirmation of coverage determinations but denying the subsequent claims or recouping payments — two of the most frequently cited areas of concern for member dentists that led to resolutions by the LDA leadership directing the LDA staff and lobbyists to draft and introduce a bill that would address these issues," Mr. Blackwell said.

Mr. Blackwell said the ADA provided support by helping draft amendments that moved the bill toward becoming law.

In the end, the passage of the law benefits the patient, Mr. Blackwell said. "Once the new law takes effect, patients will be able to rely on the information in a prior authorization in deciding whether or not they can afford to have a certain procedure," he said. "And all these related issues should cease to be a problem."

Follow all of the ADA's advocacy efforts at ADA.org/advocacy. For more information on the ADA's principles for model legislation, which state dental societies can use in their legislative efforts, visit ADA.org/advocacy.