Texas Senate Bill SB1090

Texas 2025 - 89th Regular

• Filed: 2/4/25

Caption

Relating to bundling and down-coding practices conducted by certain providers of dental benefits.

Impact

The impact of SB1090 is expected to extend into the operational aspects of dental billing practices and could significantly affect how dental services are reimbursed. If enacted, the bill would require providers or health insurance issuers to conduct a professional review of dental claims before making any changes to the submitted procedure codes. This may increase transparency in the billing process and potentially reduce disputes between healthcare providers and insurers over claim adjustments, thereby promoting fair treatment for providers.

Summary

Senate Bill 1090 addresses the practices of bundling and down-coding conducted by providers of dental benefits. The proposed legislation specifically seeks to limit the ability of these providers and issuers of health insurance policies to alter the procedure codes submitted by dentists without proper justification. Bundling refers to the practice of combining distinct procedures for billing purposes, while down-coding involves adjusting submitted claims to reflect lower-cost codes. This bill aims to establish clearer standards for these practices to ensure that claims are accurately billed and properly handled.

Contention

Notably, SB1090 is intended to take effect on January 1, 2026, which gives stakeholders in the dental and insurance industries time to prepare for the changes in billing practices. However, debates may arise around the administrative burdens this legislation could impose on insurance providers and the extent to which it could impact their ability to manage costs effectively. Advocates for the bill may argue it protects providers from unjustified claim modifications, whereas opponents may raise concerns over potential increases in insurance premiums or operational challenges that could arise from stringent regulations.

Texas Constitutional Statutes Affected

Insurance Code

• Chapter 1451. Access To Certain Practitioners And Facilities
  • Section: New Section