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Relating to certain required disclosures and prohibited practices of certain employee benefit plans and health insurance policies that provide benefits for dental care services.
No significant fiscal implication to the State is anticipated.
HB 2486 would amend the Insurance Code as it relates to employee health benefit plans providing dental insurance. This bill would require a person or entity who provides an employee benefit plan or health insurance policy to establish an internet website to provide resources and information to dentists, insureds, participants, employees, and members. The bill lays out what information must be made available on the website.
The bill would require a health benefit plan or insurance policy to provide one or more methods of payment or reimbursement that provide the dentist with 100% of the contracted amount of the payment or reimbursement and that do not require the dentist to incur a fee to access the payment or reimbursement. It would also require the disclosure of any fees associated with reimbursement under the plan or policy.
The bill would prohibit a benefit plan or insurance policy from deducting the amount of an over payment of a claim from a payment or reimbursement for dental care provided by a dentist who did not receive the payment.
The bill would also revise and prescribe in detail the process for handling payment and reimbursement of services requiring prior authorization.
Most of the problems this legislation addresses arise out of the over-regulation of the health care and health insurance industries at both the federal and state levels. Between insurance coverage mandates and the almost complete micromanagement of these industries, health care and health insurance operate in an environment that is nothing like a free market. This bill is an attempt to sort out issues that would normally be resolved through the forces of market competition if these industries were regulated lightly and not subject to mountains of mandates.
The answer to overregulation is not to pile on still more regulation. The answer is to deregulate and let market forces take their natural course which would result in the provision of more options for quality service at prices consumers can afford and are willing to pay.
Unfortunately, even if the state of Texas totally deregulated these industries they would still be a mess due to federal overregulation. For this reason we will withhold our objection to this bill which may protect dentists and dental patients to some extent from health benefit plans and insurers who take advantage of their advantageous position created by state and federal regulators manipulating the marketplace to pick winners and losers.