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17:48G-2 Dental decisions made by insurer. |
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New Jersey Statutes (Unannotated) / NEW JERSEY GENERAL AND PERMANENT STATUTES (UPDATED THROUGH P.L.2023, c.256, and J.R.18) / TITLE 17 CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE |
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17: 48G-2 Dental decisions made by insurer. 17: 48G-2 Dental decisions made by insurer. 2. a. An insurer may make dental decisions in connection with the processing or payment of dental claims or otherwise in the course of its dental benefit administration activity. Dental decisions made by an insurer shall be consistent with the following: (1) an initial adverse dental decision shall be made by a dentist duly licensed in this or another state; (2) if a treating dentist questions the adverse dental decision and specifies in writing the basis of the disagreement with the adverse dental decision, the insurer, within 30 days shall: (a) designate a reviewing dentist who is duly licensed in this State or who has been issued a limited registration certificate...
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