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S 807

Relates to fees for a activities undertaken pursuant to a lake program

2025 Regular Session Introduced by Rachel May

Summary — S.807 (An Act relative to dental insurance assignment of benefits)Status: Enacted (Signed into law as Chapter 92 on February 14, 2025) Introduced by: Senator Patrick M.

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Bill Summary · S 807

Summary — S.807 (An Act relative to dental insurance assignment of benefits)

Status: Enacted (Signed into law as Chapter 92 on February 14, 2025)
Introduced by: Senator Patrick M. O’Connor (First Plymouth and Norfolk)
Primary subject: Dental insurance — assignment of benefits

Purpose and intent

This law creates a new chapter (Chapter 176X: Dental Benefit Plans) in the Massachusetts General Laws to allow insured dental patients to direct their dental plan benefits to be paid directly to a non‑contracting dental provider (i.e., an out‑of‑network dentist) who meets the plan’s credentialing criteria. The statute is intended to expand payment options for patients and clarify insurers’ obligations when a subscriber executes a written assignment (direction to pay).

Key provisions

  • Establishes Chapter 176X and definitions for terms including “carrier,” “dental benefit plans,” “third‑party administrator,” “self‑insured group,” and “written direction” (assignment of benefits).
  • Assignment of benefits:
    • Dental benefit plans must allow an insured person to direct in writing that plan benefits be paid directly to a dental care provider who is not a contracted provider but meets the plan’s credentialing criteria.
    • If the subscriber executes the written direction and provides written notice to the plan/carrier, the carrier must pay benefits directly to that dental care provider.
    • The amount paid to the non‑contracting dental provider must be at least equal to the amount the carrier would pay participating (in‑network) dentists for the same services.
  • Record review:
    • The paying entity has the right to review the dentist’s records related exclusively to that subscriber/patient to verify the service was rendered.
  • Exclusions:
    • The assignment requirement does not apply to certain limited benefit or specialty coverages, including hospital confinement indemnity, disability income, accident‑only, long‑term care, Medicare supplement, limited benefit health, specified disease indemnity, sickness or bodily injury/death by accident, and other limited benefit policies.

Who is affected

  • Insured individuals covered by stand‑alone dental plans or dental benefits within health plans in Massachusetts.
  • Dental providers who are not contracted with a given carrier but meet credentialing requirements.
  • Carriers, dental service corporations, HMOs, preferred provider arrangements, third‑party administrators, and self‑insured groups operating in Massachusetts.

Potential impacts

  • Increases patient control over payment direction, potentially improving access to chosen providers.
  • Requires carriers to pay out‑of‑network providers at parity with in‑network payment levels for the subscriber who assigns benefits, which could affect carriers’ costs and network contracting dynamics.
  • Creates administrative obligations for carriers to accept written assignments and to review provider records for verification.

Legislative history (selected)

  • Filed/Presented: January 17, 2025
  • Passed Senate: January 22, 2025
  • Passed House/Delivered to Governor: February 12, 2025
  • Signed by Governor: February 14, 2025 (Chapter 92, 2025)

Note: The bill text and sponsor in the Massachusetts filing identify Senator Patrick M. O’Connor as the petitioner. Some metadata provided with the request (alternate title, or a list of federal sponsors) appears inconsistent with the Massachusetts legislative document and likely reflects data errors; this summary relies on the bill text and Massachusetts legislative history contained in the filing.

Compiled from official sources — confirm details with the bill’s official record.

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