HB1091 clarifies that dentists are “providers” for purposes of Maryland insurance law, allows dentists who are not contracted (nonpreferred) to receive an insured’s or enrollee’s assignment of benefits, and generally prohibits insurers and dental plan organizations from refusing to directly reimburse nonpreferred dentists under such assignments. The bill also requires nonpreferred dentists to give patients a set of pre‑service disclosures and to submit a Commissioner‑developed disclosure form to document any assignment of benefits.
The change shifts a practical payment route from patients to nonpreferred dental providers, creates new documentation duties for dentists, and obliges regulators to produce standardized forms. Insurers and dental plans retain narrow exceptions allowing them to refuse direct reimbursement in limited scenarios; the measure takes effect January 1, 2027, which compresses the lead time for operational changes by regulators and market participants.
At a Glance
What It Does
The bill amends Maryland insurance definitions to explicitly include dentists and prohibits insurers and dental plan organizations from blocking assignments of benefits to dentists or refusing direct reimbursement to nonpreferred dentists, subject to limited exceptions. It requires nonpreferred dentists to provide specific pre‑service cost and billing disclosures and to file a Commissioner‑created form documenting any assignment of benefits.
Who It Affects
Nonpreferred (out‑of‑network) dentists, dental plan organizations, health insurers writing dental or medical plans covering dental services, and enrollees or insureds who receive dental care from nonpreferred providers. State regulators will also be responsible for producing the required disclosure forms and overseeing compliance.
Why It Matters
The bill gives nonpreferred dentists a clearer path to be paid directly by plans, reduces a contractual barrier insurers have used to limit direct payments to providers, and standardizes patient disclosures—actions that can change negotiation leverage between networks and out‑of‑network dentists and affect cash flow, billing practices, and plan administration.
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What This Bill Actually Does
HB1091 does two things at once: it folds dentists explicitly into Maryland’s insurance definitions, and it creates a statutory right for dentists to receive an insured’s or enrollee’s assignment of benefits. By naming dentists in the provider and similarly licensed provider definitions, the bill makes clear that dental providers and group dental practices are treated alongside physicians for allocation and comparison purposes under the subtitle.
On payments, the bill bars insurers and dental plan organizations from contractually prohibiting assignment of benefits to a dentist and generally stops them from refusing to directly reimburse a nonpreferred dentist when a patient assigns benefits. If an enrollee or insured does not assign benefits, the plan must still send the enrollee a payment with an itemized statement showing which claim was paid, how much was paid, what the enrollee owes, and that the enrollee should use the payment to pay the provider.To protect patient awareness, the bill requires any nonpreferred dentist who seeks an assignment to deliver a set of pre‑service disclosures before providing care—warning the patient that the dentist is nonpreferred, that noncovered services may be charged to the patient, that balance billing for covered services may occur, an estimate of costs, payment terms, and interest terms if any.
The provider must also use a disclosure/assignment form developed by the Maryland Insurance Commissioner to document the assignment.Insurers and dental plans keep narrow defenses allowing them to refuse direct reimbursement in specified circumstances—for example, if they paid benefits to the enrollee before receiving notice of the assignment, if the enrollee withdraws the assignment, or where the enrollee already paid the provider in full. The insurer rules also include an exception for inadvertent administrative errors; the dental plan parallel omits that specific exception.
The Commissioner must prepare the forms the statute mandates, but the bill does not set a schedule for that work; the law becomes effective January 1, 2027.
The Five Things You Need to Know
The bill amends the insurance subtitle to explicitly include dentists and group dental practices in the definitions of 'provider' and 'similarly licensed provider' (Article – Insurance §14‑201).
Insurers may not contractually prohibit assignment of benefits to a dentist nor refuse to directly reimburse a nonpreferred dentist who holds an assignment, subject to limited exceptions (Article – Insurance §14‑205.3(b)).
A nonpreferred dentist who seeks assignment must give the insured/enrollee pre‑service disclosures: nonpreferred status, potential charges for noncovered services, potential balance billing for covered services, an estimated cost, payment terms, and any interest to be charged (Article – Insurance §14‑205.3(d) and §14‑410.1(d)).
The Maryland Insurance Commissioner must develop standardized disclosure/assignment forms; the nonpreferred dentist must submit the form to document the assignment when seeking direct reimbursement (Article – Insurance §14‑205.3(e),(f) and §14‑410.1(e),(f)).
Insurers and dental plan organizations may refuse direct reimbursement only in limited situations: notice after the plan already paid the enrollee, an enrollee withdrawal before payment, or when the enrollee paid the provider in full—insurers also may refuse because of inadvertent administrative error (Article – Insurance §14‑205.3(g) and §14‑410.1(g)).
Section-by-Section Breakdown
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Adds dentists into provider and 'similarly licensed' definitions
The bill inserts 'dentist' into the statutory definition of 'provider' and establishes criteria for a 'similarly licensed provider' for dentists: either a dentist licensed in Maryland who performs the same or similar dental services, or a group dental practice consisting of such dentists. Practically, this ties dental practices to the same comparative standard used for physicians, which matters for network comparisons, continuity‑of‑care determinations, and any other provisions that rely on the similarly licensed standard.
Assignment of benefits, payment reporting, and pre‑service disclosures for insurers
This section bars insurers from forbidding assignment of benefits to a dentist and generally requires direct reimbursement to a nonpreferred dentist when a valid assignment exists. If the enrollee did not assign, insurers must provide an itemized payment to the enrollee specifying the claim, amounts paid, enrollee responsibility, and an instruction to use payments to pay the provider. The section also prescribes exact pre‑service disclosures that nonpreferred dentists must deliver and requires the provider to submit a Commissioner‑developed form to document the assignment. Finally, it lists four narrow circumstances—including administrative error—where an insurer may refuse direct reimbursement.
Parallel assignment, disclosures, and reimbursement rules for dental plans
A new section mirrors the insurer rules for regulated dental plan organizations: prohibition on blocking assignment, mandatory content for payments sent to enrollees where no assignment exists, required pre‑service disclosures, and the requirement that nonpreferred dentists file the Commissioner’s form to document assignments. The exceptions allowing a dental plan to refuse reimbursement are narrower than the insurer list: notice after payment, enrollee withdrawal, or enrollee payment in full—conspicuously, the dental plan provision omits the insurer’s 'inadvertent administrative error' exception.
January 1, 2027 implementation
The statute takes effect January 1, 2027. That puts practical pressure on the Insurance Commissioner and market participants to create, distribute, and operationalize the disclosure/assignment forms and to adjust claims systems and contractual language before the start date.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Nonpreferred (out‑of‑network) dentists: They gain a statutory pathway to receive payment directly from insurers or dental plans via assignment, improving cash flow and reducing the need to chase patient‑collected reimbursements.
- Patients/enrollees who receive care from nonpreferred dentists: They receive mandated pre‑service disclosures about cost and billing, and, if they do not accept an assignment, an itemized payment statement that clarifies what was paid and what they owe.
- Group dental practices and specialists: Practices that treat insured patients but remain out of network can secure reimbursements more predictably and document assignments using a standardized Commissioner form.
Who Bears the Cost
- Insurers and dental plan organizations: They face operational and administrative costs to accept assignments, change payment flows, produce required statements, and update claims systems; they may also face higher out‑of‑network payments and altered network negotiating leverage.
- Maryland Insurance Administration (Commissioner’s office): The agency must draft, issue, and support implementation of disclosure/assignment forms and may see increased compliance oversight duties without additional staffing or funding specified in the bill.
- Enrollees/insureds: While the bill protects the ability to assign benefits, patients who sign an assignment may still be exposed to balance billing if a nonpreferred dentist charges more than plan allowable amounts; the law does not cap balance bills and thus shifts the financial risk in some cases to enrollees who choose out‑of‑network care.
Key Issues
The Core Tension
The central dilemma is between improving nonpreferred dentists’ ability to be paid (and patients’ information at point of care) versus preserving plan network economics and predictability: assignment of benefits empowers providers but risks undermining negotiated network discounts and raising plan costs — a trade‑off the bill addresses procedurally but does not fully resolve substantively.
The bill creates a practical tension between access for nonpreferred dentists to be paid directly and insurers’ ability to manage costs through negotiated network rates. Allowing assignments weakens a network’s exclusive payment leverage and could increase out‑of‑network reimbursements unless plans tighten contracting or adjust rates.
At the same time, the statute preserves limited exceptions (e.g., notice after payment, withdrawal, paid in full) but treats insurers and dental plan organizations slightly differently—the insurer provision includes an 'inadvertent administrative error' carve‑out that the dental plan parallel omits—opening a source of future litigation over parity and interpretation.
Operationally, the Commissioner must produce disclosure and assignment forms but the bill sets no deadline or enforcement timetable. That raises immediate implementation risks: insurers, dental plans, and providers will need to change claims systems, intake procedures, and contract language in a compressed window before the January 1, 2027 effective date.
The statute also leaves open how balance billing disputes will be resolved, what constitutes an adequate cost estimate, and how notices of assignment will be reliably transmitted and verified—questions that could generate administrative appeals, contested audits, and litigation absent further regulatory guidance.
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