Colorado Legislation SB190 was signed into law in April, and becomes effective August 9, 2017. “SB 190 prohibits dental plans from setting fees for services that are not ever covered by a patient’s specific plan.” What does this mean for your practice, when a procedure is “not a covered benefit” this will allow the practice to charge UCR fees for the procedure. This does not pertain to a procedure denied for waiting periods, frequency, etc.
There is always the “but or however” isn’t there and here it is. I suspect you will be hearing from the insurance companies soon. This is new to Colorado but not new to the insurance companies, they have been dealing with this type of legislation from other states for awhile. Check your contracts with the insurance providers, there may me a clause in the contracts that deals with this legislation, if not you may be getting one. I have seen a clause that says you agree to only charge the insurance companies fees if you want to be listed on their website, but that you were free to charge UCR fees for non covered procedures, the practice would still be in network but they would not list you on the insurance website. So be careful watch your mail and read your contracts before making any changes.
