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Mississippi passes bill on dental benefits prior authorization rules

May 24, 2019

By David Burger

DDB logoEditor’s note: This is the 25th story in the Decoding Dental Benefits series featuring answers and solutions for dentists when it comes to the world of dental benefits and plans. The series is intended to help untangle many of the issues that can potentially befuddle dentists and their teams so that they can focus on patient care.

Jackson, Miss. — Mississippi Governor Phil Bryant signed a bill March 19 that makes it harder for dental procedures to be denied once they are proven medically necessary.

HB 752 generally prohibits dental service contractors from denying any claim that has been authorized as reimbursable by the contractor. Insurers also must establish appeal procedures for any claim by a dentist or a subscriber that is denied based upon lack of medical necessity.

Dr. Gwin
Dr. Gwin
“It’s all about fairness,” said Dr. Sherry Gwin, Mississippi Dental Association president. “It’s so frustrating when you think you have all of your ducks in a row, and then a claim is denied. Patients should get the full benefits they’re entitled to.”

State Rep. Jody Steverson authored the bill. “In some cases, insurance companies provide dentists with preauthorized treatment coverage amounts and then later decrease those coverage amounts from the initial quote,” the representative told ADA News. “This is a growing issue for our dentists and their patients alike. Sometimes it can be changed months after the treatment was provided. This leaves both the dentists and their patients with no way of knowing what they will owe. This bill will help make sure that my constituents are able to know what expenses they have for dental care without later finding out they are left with additional unbudgeted costs. In essence, the bill will help save money for Mississippians for dental care.”

The law also requires claim denials be done by a licensed dentist and prohibits dental consultants from being an employee of the dental service contractor or dental insurer. Denials based on medical necessity must include the name, applicable specialty designation, license number together with state of issuance, and the direct telephone number of the licensed dentist making the adverse determination.
 
The bill passed 103-9 in the House in January, and in March the Senate passed it unanimously.

“It’s been a long time coming,” Dr. Gwin said.

The new law goes into effect Jan. 1, 2020.

Dr. Gwin mentioned a similar law that was passed last year in neighboring Louisiana and went into effect Jan. 2. The Louisiana law prohibits dental carriers from denying any claim for a procedure where the insurer has issued a prior authorization.

Other bills related to prior authorization have been brought forward in other states this year, including Virginia, North Carolina, Texas, Nevada and Oklahoma.

The ADA provided technical assistance to the Mississippi Dental Association in support of the new law. To help state dental societies enact legislation to help dentists and their patients, the Council on Dental Benefit Programs has developed model legislation that addresses issues such as network leasing, medical loss ratios, refund requests and more.

Based on decades of state advocacy experience, the ADA Department of State Government Affairs provides research and examples of dental benefit advocacy approaches for members and societies to use in helping patients gain access to the benefits for which they have paid. To contact State Government Affairs, call 1-312-440-2525.

The ADA has also created an online landing page for dental benefits information that can help dentists address and resolve even their most vexing questions. Go to ADA.org/dentalbenefits, part of the ADA Center for Professional Success.

Staff from the Center for Dental Benefits, Coding and Quality can help dentists with dental benefits-related and coding problems, questions and concerns. Call the ADA's Third Party Payer Concierge at 1-800-621-8099 or email dentalbenefits@ada.org.

Previous installments in the Decoding Dental Benefits series are available at ADA.org/decoding.

For more information on ADA advocacy, visit ADA.org/advocacy.