IL HB4789

Dental carriers cannot automatically enroll providers in leased networks without allowing opt-out rights for existing network providers.

Dental carriers must provide written notice 60 days before assigning or leasing a network contract, including specific contract terms, policy manual, fee schedule, and a URL where providers can access these materials.

Dental carriers cannot cancel or penalize dentists based on whether they accept assignment or lease terms, and must offer providers the option to contract directly with entities gaining network access.

Dental carriers cannot deny claims for procedures covered under prior authorization except in limited circumstances: benefit maximums reached, inadequate documentation, changed patient condition affecting medical necessity, fraud, duplicate payment, or ineligibility the carrier could not have known.

Dental carriers cannot recoup payments solely due to patient ineligibility if the carrier erroneously confirmed coverage despite having sufficient information indicating ineligibility.