KRS 304.17C-137: Assignment of benefits under a dental insurance plan -- Procedures --

Revocation -- Construction.

(1) (a) An insurer providing coverage under a dental benefit plan shall honor a

written assignment of benefits due under the plan that is:

1. Made:

a. By a covered person to a provider for dental services provided to

the covered person; and

b. On a form established by the commissioner in an administrative

regulation promulgated in accordance with KRS Chapter 13A and

subsection (2) of this section; and

2. Signed by the covered person and the provider.

(b) A provider with a valid assignment under paragraph (a) of this subsection

shall provide the following to the insurer when submitting a request for

payment pursuant to the assignment:

1. A copy of the dually signed assignment; and

2. Any information or documentation necessary for verifying coverage, or

required for claims processing, under the dental benefit plan.

(c) 1. Upon a provider's compliance with paragraph (b) of this subsection, the

insurer shall make payments for covered serv ices directly to the

provider.

2. A payment made to a provider under subparagraph 1. of this paragraph

shall be made according to the same criteria and payment schedule

under which the insurer would have been required to make the payment

to the covered per son if the benefits due under the plan had not been

assigned.

(2) The form established by the commissioner under subsection (1)(a)1.b. of this

section shall include a notice informing the covered person that:

(a) The provider, as applicable:

1. Is an out-of-network provider;

2. May charge the covered person for noncovered services; and

3. May charge the covered person for any portion of the cost of a covered

service that is not reimbursed under the dental benefit plan;

(b) Any assignment of benefits is optional; and

(c) If the covered person has accrued a credit balance on his or her account, the

provider shall:

1. Notify the covered person of the credit balance with the provider within

thirty (30) days; and

2. a. Except as provided in subdivision b. of this subparagraph, refund

any credit balance that has accrued on the covered person's

account with the provider within thirty (30) days of receiving a

request for refund from the covered person; and

b. If, under the assignment, the provider collects payment fr om the

covered person and subsequently receives payment from the

insurer, refund the covered person within thirty (30) days of

receiving the payment from the insurer unless the provider and

covered person agree otherwise in writing.

(3) (a) An assignment o f benefits may be revoked by the covered person, with or

without the consent of the provider, by submitting the revocation, in writing,

to the insurer.

(b) An insurer that receives a revocation referenced in paragraph (a) of this

subsection shall promptly send a dated and time -stamped copy of the

revocation to the provider.

(c) A revocation made in accordance with this subsection shall:

1. Become effective when the insurer receives a copy of the revocation;

and

2. Only be effective for any charges incurred on or after the effective date

established under subparagraph 1. of this paragraph.

(4) This section shall not be construed to limit an insurer's ability to:

(a) Determine the scope of a dental benefit plan's benefits, services, or other

terms that are not in conflict with this section; or

(b) Negotiate any contract with a health care provider regarding reimbursement

rates or any other lawful provisions that are not in conflict with this section.