88R14088 CJD-D
By: Bettencourt S.B. No. 2065
A BILL TO BE ENTITLED
AN ACT
relating to the recovery of overpayments made to dentists by
certain employee benefit plans and health insurers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1451.206, Insurance Code, is amended by
adding Subsections (d) and (e) to read as follows:
(d) An employee benefit plan or health insurance policy
provider or issuer may not recover an overpayment made to a dentist
unless:
(1) not later than the 180th day after the date the
dentist receives the payment, the provider or issuer provides
written notice of the overpayment to the dentist that includes the
basis and specific reasons for the request for recovery of funds;
and
(2) the dentist:
(A) fails to provide a written objection to the
request for recovery of funds and does not make arrangements for
repayment of the requested funds on or before the 45th day after the
date the dentist receives the notice; or
(B) objects to the request in accordance with the
procedure described by Subsection (e) and exhausts all rights of
appeal.
(e) An employee benefit plan or health insurance policy
provider or issuer shall provide a dentist with the opportunity to
challenge an overpayment recovery request and establish written
policies and procedures for a dentist to object to an overpayment
recovery request. The procedures must allow the dentist to access
the claims information in dispute.
SECTION 2. The changes in law made by this Act apply only to
an employee benefit plan for a plan year that commences on or after
January 1, 2024, or a health insurance policy delivered, issued for
delivery, or renewed on or after January 1, 2024, and any provider
network contract entered into on or after the effective date of this
Act in connection with one of those plans or policies.
SECTION 3. This Act takes effect September 1, 2023.