38.2-3407.17 - Payment for services by dentists and oral surgeons. - Virginia Statutes

§ 38.2-3407.17. Payment for services by dentists and oral surgeons.

A. As used in this section:

"Covered services" means the health care services for which benefits undera policy, contract, or evidence of coverage are payable by a dental plan,including services paid by the insureds, subscribers, or enrollees becausethe annual or periodic payment maximum established by the dental plan hasbeen met.

"Dental plan" includes (i) an insurer proposing to issue individual orgroup accident and sickness insurance policies providing hospital, medical,and surgical or major medical coverage on an expense-incurred basis, (ii) anentity providing individual or group accident and sickness subscriptioncontracts, (iii) a dental services plan offering or administering prepaiddental services, (iv) a health maintenance organization providing a healthcare plan, and (v) a dental plan organization.

B. No contract between a dental plan and a dentist or oral surgeon mayestablish the fee or rate that the dentist or oral surgeon is required toaccept for the provision of health care services, or require that a dentistor oral surgeon accept the reimbursement paid as payment in full, unless theservices are covered services under the applicable dental plan.

C. This section shall apply with respect to any contract between a dentalplan and a dentist or oral surgeon for the provision of health care topatients that is entered into, amended, extended, or renewed on or after July1, 2010.

D. The Commission shall have no jurisdiction to adjudicate individualcontroversies arising out of this section.

(2010, cc. 583, 734.)