Over the years, legislation has been passed in most states that prohibit dental insurers from requiring a contracted dentist to accept a discount on services that are non-covered under a patient's dental policy. It is important to note that dental providers in these states are not required to accept any discounts on services listed as non-covered regardless of what is stated on a patient's explanation of benefits. The patient’s liability for non-covered services is between the dentist and the patient. Except when the patient has a federally funded plan as these plans are governed by federal law and not state law.
Please keep in mind that there is a difference between denied services and services that are considered non-covered. Denials for age or frequency limits, inclusive procedures, alternate benefits, maximum benefits being applied, and waiting periods are NOT considered non-covered procedures and negotiated rates will still apply unless explicitly stated on the patient's EOB. Non-covered services are limited to procedures that are not covered under a patient's plan no matter the circumstance.
It is important to note that plans under federal regulation are not governed by state laws. Therefore, the legislation for non-covered services do not apply to these plans. Plans that are excluded are self-funded plans, Medicaid/Medicare plans, Medical supplement plans, government and school plans (except HMO or fully insured plans), Indemnity plans, and CHIP plans. Click here to access a free tool that is helpful to use when trying to determine whether or not a plan is self-funded. For more details on the states that currently have legislation for the non-covered services, please see below.