General Laws of Massachusetts - Chapter 176E Dental Service Corporations - Section 7 Contracts between corporation and dentist; disclosure of fees to patients

Section 7. Every registered dentist shall have the right, on complying with such rules and regulations as the corporation may make, to enter into a written agreement with a dental service corporation, doing business in the city or town where the said dentist resides or has his usual place of business to perform dental service. This chapter shall not change the normal relations between dentists and patient except as to the manner and amount of fees which are to be paid by the dental service corporation to participating dentists on behalf of the subscriber. No restriction shall be placed by any such corporation upon its participating dentists as to methods of diagnosis or of treatment. No officer, agent or employee of a dental service corporation shall influence or attempt to influence a subscriber or a covered dependent in his choice of a participating dentist. A dental service corporation shall furnish lists of participating dentists to subscribers or the employer, employees or other representatives of group subscribers. A subscriber or covered dependent, subject to the by-laws, rules and regulations of a dental service corporation and the terms and provisions of his subscription certificate, shall be entitled to the benefits of this chapter upon receiving dental service from any participating dentist or nonparticipating dentist within the commonwealth or, in the discretion of the corporation, upon receiving dental service outside the commonwealth. A corporation may terminate its agreement with any participating dentist at any time (a) for failure to comply with the reasonable rules and regulations of such corporation including without limitations such rules and regulations as may be adopted governing the keeping of accounts, records and statistics, the making of reports and proof of services rendered, or (b) for presenting any fraudulent, unreasonable or improper claim for payment, or compensation.

The words “Usual fee” as used in this paragraph means the fee usually charged by a nonparticipating dentist for substantially similar services to patients who are not subscribers or covered dependents of a dental service corporation. The subscriber, or the covered dependent if the covered dependent is not a minor, shall inform the dentist that he may be entitled to benefits from a dental service corporation. If so informed, a nonparticipating dentist, prior to establishing a dentist-patient relationship between himself and such person, shall inform such person that he is entitled to charge him, for covered services, an amount equal to his usual fee less a reduction in benefits equal to the reduction in fees paid to participating dentists approved by the commissioner in consideration of the ease and certainty of collection of said fees by participating dentists and that such amount may be more than would be incurred by such person if he obtained the services of a participating dentist. In addition, prior to beginning a particular procedure or plan of treatment, each nonparticipating dentist shall inform such person of his usual fee, which may be estimated for the purpose of complying with this paragraph for such procedure or plan of treatment. A subscriber or covered dependent shall be entitled to benefits determined in accordance with (a) the applicable table of allowances approved by the commissioner for services rendered by nonparticipating dentists within the commonwealth or (b) if the subscriber or covered dependent is entitled to benefits under a plan for which a table of allowances is not established, the methods approved by the commissioner for determining the amount of benefits for services rendered within the commonwealth by nonparticipating dentists; provided that, in determining the benefits in accordance with clauses (a) or (b), the commissioner shall give weight to the costs a dental service corporation incurs in administering payments made directly to subscribers; and provided, further, that the benefits determined in accordance with clauses (a) or (b) shall be further reduced by such amount or percentage as is equal to the reduction in fees paid to participating dentists approved by the commissioner in consideration of the ease and certainty or collection of said fees by participating dentists. The usual fee for the treatment rendered or contemplated along with all other information usually required by a dental service corporation with respect to determining the benefits available to subscribers or covered dependents shall be reported by the nonparticipating dentist to the dental service corporation. Any by-laws or rules or regulations of a dental service corporation with respect to confirming patient eligibility and determining the extent of benefits available prior to treatment and any prior benefit approval provisions to which a subscriber is subject under the applicable certificate which apply to participating dentists shall also apply to nonparticipating dentists. The benefits available to a subscriber or covered dependent may not be assigned or seized, taken, appropriated or otherwise applied by means of any legal or equitable process without the prior consent of the applicable dental service corporation.

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Last modified: September 11, 2015