How does the Patient Bill of Rights help patients?

  • It forces insurers to explain if treatment is based on the least costly option rather than the BEST option. This is important for the patient to understand because insurers often downgrade treatment to the least costly option which is not in the patient’s best interest. Insurers should never interfere with a diagnosis or treatment plan without seeing a patient clinically. 

  • Disclosing the amount covered or method used in determining reimbursement aids dental offices in ACCURATELY determining the patient’s copay. This is important to create transparency in pricing for the patient. This information should be available online and should be accurately updated when plans change. 

  • Any plan must have website with accurate and non-misleading info to assist offices in providing patients with estimates - in or out-of-network. Again, this is necessary to provide the patient accurate and timely information about copays so there is no surprise billing. 

  • In cases where dentists send a pre-determination of benefits, it is important that the insurer honor this information and not change its determination after treatment is performed. To avoid surprising patients with unanticipated copays, insurers must honor predetermination of benefits.