The bill is expected to significantly impact the way dental services are reimbursed by health insurers. Legally, it requires health plans to provide clear information regarding the fees associated with fee-based payments, enabling providers to make informed decisions. Additionally, this requirement reinforces the right of dental providers to choose whether to participate in fee-based payment arrangements. The provisions within the bill become operative on April 1, 2026, impacting contracts issued or renewed on or after that date.
Summary
Senate Bill 386, introduced by Senator Limn, addresses the payment methods for dental providers under the Knox-Keene Health Care Service Plan Act of 1975. The bill mandates that health care service plans or health insurers offering payments directly to dental providers must establish a non-fee-based payment method as the default option. Notably, this legislation emphasizes obtaining affirmative consent from dental providers before opting into a fee-based payment system. This measure aims to enhance transparency and ensure that providers understand the implications of their payment choices.
Sentiment
The sentiment surrounding SB 386 appears to be generally positive among advocates for dental care providers, as it grants them increased agency in choosing payment structures that work best for their practices. However, there may be concerns from insurers regarding the administrative burden of implementing these consent mechanisms. Overall, the bill is seen as a step towards greater fairness and accountability in the dental reimbursement process.
Contention
One notable point of contention is whether the affirmative consent model will create barriers for providers by complicating the payment process or if it will simply serve to protect their interests better. Additionally, the implications of this bill on insurance operations and the potential for increased costs due to compliance measures remain important considerations for the insurance industry.