Rhode Island General Laws 27-19-54. Dental insurance assignment of benefits
Every entity providing a contract of insurance subject to this chapter shall allow, as a provision in a group or individual policy, contract, or health benefit plan for coverage of dental services, any person insured by the entity to direct, in writing, that benefits from a health benefit plan, policy, or contract be paid directly to a dental care provider who has not contracted with the entity to provide dental services to persons covered by the entity but otherwise meets the credentialing criteria of the entity and has not previously been terminated by the entity as a participating provider. If written direction to pay is executed and written notice of the direction to pay is provided to the entity, the insuring entity shall pay the benefits directly to the dental care provider. Any efforts to modify the amount of benefits paid directly to the dental care provider under this section may include a reduction in benefits paid of no more than five percent (5%) less than the benefits paid to participating dentists. The entity paying the dentist, pursuant to a direction to pay duly executed by the subscriber, shall have the right to review the records of the dentist receiving the payment that relate exclusively to that particular subscriber/patient to determine that the service in question was rendered.
History of Section.
P.L. 2004, ch. 268, § 2; P.L. 2004, ch. 386, § 2.
Terms Used In Rhode Island General Laws 27-19-54
- Contract: A legal written agreement that becomes binding when signed.
- health benefit plan: means health insurance coverage and a group health plan, including coverage provided through an association plan if it covers Rhode Island residents. See Rhode Island General Laws 27-19-1
- in writing: include printing, engraving, lithographing, and photo-lithographing, and all other representations of words in letters of the usual form. See Rhode Island General Laws 43-3-16
- person: may be construed to extend to and include co-partnerships and bodies corporate and politic. See Rhode Island General Laws 43-3-6
- provider: means a healthcare professional or a healthcare facility. See Rhode Island General Laws 27-19-1