Pennsylvania Bill Would Hold Dental Insurers to Their Word on Benefit Quotes
A newly introduced bill would require dental insurers to honor benefit estimates, expand provider access to claims data, and impose financial penalties for inaccurate information.
Pennsylvania lawmakers have introduced legislation that could significantly reduce one of dentistry’s most persistent administrative headaches: inaccurate insurance benefit estimates.
House Bill 2722 would require dental insurers to honor benefit information provided to dentists and patients, whether communicated verbally, electronically, or in writing. Under the proposal, any quoted benefit amount would become binding during claim adjudication unless fraud, material misrepresentation, or a change in patient eligibility occurred after the estimate was provided.
The bill also seeks to improve transparency by requiring insurers to maintain secure online portals giving dental practices around-the-clock access to patient eligibility, remaining benefits, claims history, payment records, denials, utilization data, and other coverage information. The portal would include at least 3 years of historical data and be updated every 24 hours.
In addition, insurers would be required to retain recordings or transcripts of benefit verification calls for at least three years and provide copies upon request. Standardized electronic interfaces would also be required to improve data access while maintaining cybersecurity safeguards.
The legislation gives Pennsylvania’s Insurance Department authority to enforce the requirements through corrective action plans, reimbursement of provider fees, and fines of up to $10,000. Insurers that fail to comply could also be required to pay a practice’s full office fee rather than the contracted reimbursement amount and face legal action if payment is delayed. Click here to read more.
