Dental providers: fee-based payments.

Senator Limón offers a proposal that would place a non-fee-based default payment method at the center of dental provider payments by health plans and insurers, with an affirmative-consent pathway for fee-based arrangements. The measure would treat consent as applicable to the dental provider’s entire practice and to all products or services covered under each contract, and it would become operative for contracts issued, amended, or renewed on or after the specified date in 2026.

The core mechanism requires plans and insurers to provide a non-fee-based default method of payment when paying dental providers directly or through a contracted vendor, while ensuring that each payment includes the accompanying claim details. A dental provider may opt in to a fee-based payment only after affirmative consent, which must be obtained before the fee-based method is used and is accompanied by information about fees, alternatives, opt-out instructions, and the provider’s ability to withdraw at any time. The consent decision must apply to the provider’s entire practice and all covered products or services, and the plan or vendor must notify the provider if a contracted partner shares profits, fee arrangements, or board involvement.

The proposal also sets out an opt-out framework, permitting a provider to revert to a non-fee-based method at any time, with the choice remaining in effect until changed. It includes a direct-contract exception for arrangements that already allow providers to choose payment methods, and it provides that the new requirements do not alter the broader scope of existing law related to plan operations. Operationally, the measure imposes disclosures at opt-in, requires that payment details accompany each transaction, and mandates reporting on vendor relationships, while tying enforcement to existing crime-related penalties for willful violations by plans or insurers.

Taken together, the measure introduces a parallel, consent-driven regime for dental provider payments within California’s regulated health plan and health insurer frameworks, applicable to post-2026 contracts and designed to increase transparency around payment arrangements. It aligns with existing Knox-Keene Act and Insurance Code structures by adding new, separate provisions rather than amending current statutes, and it contemplates no state funding or local reimbursements while imposing private-sector implementation costs and criminal enforcement mechanisms for violations.