SLS 12RS-706 ENGROSSED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2012
SENATE BILL NO. 345
BY SENATOR MORRISH
HEALTH/ACC INSURANCE. To provide with respect to dental service contractors.
(8/1/12)
AN ACT1
To amend and reenact R.S. 22:1155, relative to the denial of dental benefit claims; to require2
certain information to be included in such denials or any written communications3
related thereto; and to provide for related matters.4
Be it enacted by the Legislature of Louisiana:5
Section 1. R.S. 22:1155 is hereby amended and reenacted to read as follows: 6
ยง1155. Denial of claims7
A dental service contractor or a contract of dental insurance shall establish8
and maintain appeal procedures for any claim by a dentist or a subscriber that is9
denied based upon lack of medical necessity. Any such denial shall be based upon10
a determination by a dentist who holds a nonrestricted license issued in the United11
States in the same or an appropriate specialty that typically manages the dental12
condition, procedure, or treatment under review. Subsequent to an initial denial, the13
licensed dentist making the adverse determination shall not be an employee of the14
dental service contractor or dental insurer. Any written communication to an15
insured or a dentist that includes or pertains to a denial of benefits for all or16
part of a claim on the basis of a lack of medical necessity shall include the name,17 SB NO. 345
SLS 12RS-706 ENGROSSED
Page 2 of 2
Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
applicable speciality designation, license number together with state of issuance,1
and the direct telephone number of the licensed dentist making the adverse2
determination.3
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Cheryl Horne.
DIGEST
Morrish (SB 345)
Present law requires a dental service contractor or a contract of dental insurance to establish
and maintain appeal procedures for any claim by a dentist or a subscriber that is denied
based on lack of medical necessity. Requires any such denial be based upon a determination
by a dentist who holds a nonrestricted license in the same or an appropriate speciality that
typically manages the dental procedure or treatment under review.
Proposed law retains present law and requires that the dentist hold a nonrestricted license
issued in the United States. Further requires the licensed dentist making the adverse
determination include, in any written communication to an insured or dentist, his name,
applicable specialty designation, license number with state of issuance, and his direct phone
number.
Effective August 1, 2012.
(Amends R.S. 22:1155)