Assignment of benefits by state: the 25 states where the ADA says a plan must pay the dentist the patient names, and the one that needs two signatures

What it says#

The document is a 12-page table from the ADA's dental insurance reform series, last updated September 3, 2021, with contents the ADA says are current as of August 2021. Its opening paragraph is the whole theory: "Assignment of benefit laws empower patients to have their benefit payment sent directly to their dentist. These laws require dental plans to pay dentists directly when the enrolled patient instructs their plans to do so." A list of 25 states follows, then a row for each state with the year, the code citation and the operative statutory language, mostly quoted.

Each row carries one of two markers, which the ADA defines: "Dental: State law applies specifically to dental plans or dentists. General: State law does not specify dental or may apply to non-dental professions." Twenty entries are marked Dental. Maryland is marked "Non-Par General (Physician)"; its statute bars an insurer from prohibiting assignment to a physician or refusing to reimburse a nonpreferred physician under one, and lists six disclosures a nonpreferred physician must make before treating. North Dakota is marked General, and the ADA adds that its "Application is uncertain as it refers to 'medical benefits.'" Illinois, Mississippi and Oklahoma carry no marker; the ADA notes a 2012 Illinois law made state employee health benefits subject to the assignment statute.

The statutes differ in what they make the plan do. The simplest, such as Tennessee's, Maine's and New Hampshire's, say the insured is entitled to assign benefits, or that the contract must permit it. Others spell out the payment: Texas's insurer "shall pay benefits directly to a physician or other health care provider" and is relieved of any duty to the patient once a written assignment is delivered with the claim; Alabama's plan must pay the provider "under the same criteria and payment schedule" it would have used, with interest; Florida's claim form "must provide an option for" direct payment and the insurer may require written attestation. Several deal with the plan that pays the patient anyway: in Nevada the insurer that receives an assignment but pays the insured "shall also pay those benefits to the provider"; in Colorado, if the covered person does not pass the payment on within forty-five days, "the carrier shall be liable for the payment directly to the provider"; in Alaska an insurer that pays the insured after written notice of the election "shall also pay indemnities to the provider."

The newest dental-specific statutes are the most operational. South Dakota (2017) and West Virginia (2020) use nearly the same words: the insurer "shall honor an assignment, made in writing," pay the dentist directly on notice of it, let the dentist bill and notify, and require a copy only on request; South Dakota adds that the patient may revoke the assignment with or without the dentist's consent. Georgia requires the plan to send the payment to the nonparticipating provider "who has the written assignment" and to notify the insured in writing when it does. Oklahoma lists four conditions: a written assignment, a copy to the insurer, a claim on the uniform form, and a copy of the claim to the insured. New Jersey requires a dental service corporation to pay an out-of-network dentist by check payable to the dentist, or jointly to dentist and patient with a signature line for each.

Two entries put conditions on the dentist. Connecticut's plan may not refuse an assignment to a dentist or oral surgeon "provided" the dentist charges insured patients no more than uninsured ones for the same services and allows the plan to review records on 48 hours' notice. Rhode Island's applies to a dental care provider who has not contracted with the plan "but otherwise meets the credentialing criteria of the entity," lets the plan reduce the direct payment by "no more than 5% less than the benefits paid to participating dentists," and gives the plan a right to review that patient's records to confirm the service was rendered. Missouri's statute requires payment in the provider's name within 30 days of complete documentation, but "shall not require" an insurer that directly contracts with certain members of a class of providers to pay non-contracted members that way.

Washington sits under its own heading, "Requires dual signature on payment." Its statute says checks for covered services from a non-participating provider "shall be made out to both the provider and the enrolled participant with the provider as the first named payee, jointly, to require endorsement by each," unless the patient shows prepayment, in which case the check goes to the patient alone; the plan may still choose to pay the provider alone.

Who it applies to#

A dental office in one of the 25 states that treats patients whose plan it does not participate with, and wants the plan's payment to come to the office rather than to the patient. In a Dental-marked state the statute names dental plans or dentists; in Maryland it names physicians, and in North Dakota the ADA itself flags that the statute may not reach dental benefits. The 25 states and the District of Columbia not in the table have, on the ADA's reading as of August 2021, no such law, and the office is left with the plan's own policy and the patient's cooperation.

What the document does not do is tell you which plans a state statute binds. Its rows quote insurance code sections aimed at insurers, health service corporations, HMOs and dental service plans; it says nothing about self-funded employer plans or about any federal question. Read it as a map of where a statute exists and what it says, and take the question of whether it reaches a particular employer's plan to counsel.

What changed#

First edition on this site. The ADA's table is a snapshot as of August 2021 and has not, at the URL the ADA publishes, been updated since; the ADA's dental insurance reform page lists its 2025 and 2026 federal advocacy but no later version of this table. A state that passed or amended an assignment law after August 2021 will not appear, and a citation may have been renumbered. Treat each row as a pointer to the statute, and read the current statute before relying on it.

Where the source is#

The document is the PDF at the ADA's dental insurance resources site, "Dental Insurance Reform: Assignment of Benefits," copyright 2021 American Dental Association, updated September 3, 2021, 12 pages; it downloaded directly and its text was read in full. It carries the ADA's disclaimer that the materials are not legal advice and that statute links go to the states' own sites. The ADA's dental insurance resources page and its dental insurance reform advocacy page, both linked above, loaded and were checked for a newer edition; none was found. The companion ADA table on virtual credit card laws has its own entry in this directory.