The Nevada Dental Association announced today it is supporting SB269 – legislation sponsored by state Sen. Ben Kieckhefer that would limit the ability of insurance companies to deny claims for preauthorized dental care provided months or even years earlier. The bill was introduced this week and is scheduled to be heard by the Senate Commerce and Labor Committee.
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.
The bill proposed by Sen. Kieckhefer, R-Reno, would prohibit dental insurance companies doing business in Nevada from attempting to recover an overpayment after one year, prohibit insurers from retroactively denying a claim that was preauthorized, require insurers to provide written notice of an attempt to recover an overpayment, and require insurers to create written procedures by which a dentist may challenge such an attempt.
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.
“This bill is important for dental practices in the state, because unlike major medical institutions, the dental practice model cannot absorb these denials,” said NDA President Dr. Mark Funke, DDS. “Dentists are responsible for informing patients about the denial, and having to be the go-between breaks the trust between dentist and patient. It puts us in an uncomfortable position when we have to go back to a patient years later and tell them that their dental work claim was denied by insurance and now there’s a balance due. No one wants to deliver that news.”
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.
NDA recently surveyed its members and found that many dentists statewide have received retroactive insurance claim denials and/or claim denials after preauthorization, sometimes years after a procedure was performed.
Dr. Funke, a longtime dentist based in Carson City, is among the many Nevada dentists who have experienced this. He said another local dentist he knows shared an incident where that dentist was billed by the insurance company approximately seven years after the dental treatment had been reimbursed by the insurance company. That dentist was then required to refund the insurance company due to the retroactive claim denial, and since the patient was deceased that dentist also had to absorb the cost.
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.