§ 27-20-49 - Dental insurance assignment of benefits. - Rhode Island Statutes

SECTION 27-20-49

   § 27-20-49  Dental insurance assignment ofbenefits. – Every entity providing a contract of insurance as defined in this chapter shallallow, as a provision in a group or individual policy, contract or healthbenefit plan for coverage of dental services, any person insured by such entityto direct, in writing, that benefits from a health benefit plan, policy orcontract, be paid directly to a dental care provider who has not contractedwith the entity to provide dental services to persons covered by the entity butotherwise meets the credentialing criteria of the entity and has not previouslybeen terminated by such entity as a participating provider. If writtendirection to pay is executed and written notice of the direction to pay isprovided to such entity, the insuring entity shall pay the benefits directly tothe dental care provider. Any efforts to modify the amount of benefits paiddirectly to the dental care provider under this section may include a reductionin benefits paid of no more than five percent (5%) less than the benefits paidto participating dentists. The entity paying the dentist, pursuant to adirection to pay duly executed by the subscriber, shall have the right toreview the records of the dentist receiving such payment that relateexclusively to that particular subscriber/patient to determine that the servicein question was rendered.