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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 ENROLLED
SENATE BILL NO. 345
BY SENATOR MORRISH
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
applicable speciality designation, license number together with state of issuance,18
and the direct telephone number of the licensed dentist making the adverse19
determination.20
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
ACT No. 648