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Insurance Reimbursement

The changing healthcare landscape is altering the way insurers pay practitioners. AAOMS remains committed to working with all parties to ensure the best outcome for its members and their patients. Please visit the Coding and Reimbursement page of AAOMS.org for additional information on this issue.

Trending State Issues: Out-of-network/Surprise Billing

With the narrowing of provider networks, patients are increasingly receiving out-of-network bills for services provided at in-network facilities. Despite the adoption of model legislation by the National Conference of Insurance Legislators in 2017, only a handful of states have introduced similar language. Because OMSs provide services at hospitals, they will likely be disproportionately affected by these bills compared to the rest of the dental community. Proposals have been introduced that require out-of-network providers to be reimbursed at a specified percentage of the usual and customary rate for the geographic area, require providers to accept assignment of benefits, prohibit balance billing, mandate arbitration or require specified patient notification before a provider can balance bill a patient.

For more information on the issues facing your state, please view the state legislative tracking map, listen to the most recent Advocacy Flash Update or contact the AAOMS Government Affairs Department.