The Nevada Dental Association (NDA) announced today that the SB269 hearing and testimonies are scheduled for Friday, April 2 at 8 a.m. The legislation sponsored by state Sen. Ben Kieckhefer, R-Reno, would limit the ability of insurance companies to deny claims for preauthorized dental care provided months or even years earlier.
These so-called retroactive claim denials occur when an insurance provider initially authorizes but later denies a claim to reimburse patients for dental services, often seeking payment from patients months or even years after the service was provided.
With the passage of Senate Bill 269, insurance companies would have one year to recover payment for a claim. They cannot retroactively deny a claim they previously approved. They would also be compelled to provide proper notice of their attempt to recover an overpayment and create written procedures by which a dentist may challenge such an attempt, if appropriate.
Claims can be denied retroactively for a number of reasons, with the most common reason being because coverage was canceled. Other common reasons include issues with eligibility and services later determined not to be covered by the dental plan.
“Many dentists throughout Nevada, and their patients, have experienced retroactive insurance claim denial after preauthorization, and in some cases a claim is denied years after a procedure was performed,” said NDA President Dr. Mark Funke, DDS. “This type of billing is unfair to patients who are surprised to learn after-the-fact their dental work claim was denied by insurance and now there’s a balance due. Senate Bill 269 seeks to close this surprise-billing loophole by putting policies in place to help protect dental practitioners and the patients they serve.”
Several states already have laws limiting an insurer’s ability to deny claims retroactively, including Alabama, Florida, Georgia, Maryland, New Hampshire, Rhode Island, Tennessee, Texas, Virginia and West Virginia.
For example, the Maryland retroactive denial of claims statute stipulates that insurers may only retroactively deny payment within one year, must give a written statement specifying the basis for the denial, may only retroactively deny payment if another entity acknowledges responsibility for the claim, and may make an adjustment to reimbursement as part of an annual contracted reconciliation process, if applicable through the agreement.
Nevada law currently does not impose any timeframe limiting the ability of insurance companies to issue a retroactive refund request.
About the Nevada Dental Association
The Nevada Dental Association is the voice and advocate for oral health care in Nevada. It promotes the highest standards of care for the public and inspires members to pursue professional excellence and personal fulfillment through education, leadership and communication. It preserves the integrity of the dental profession, strengthens the doctor-patient relationship and promotes the Principles of Ethics and Code of Professional Conduct of the American Dental Association. Visit www.NVDA.org.