Assembly Bill 52, introduced in the Nevada State Legislature on April 24, 2025, aims to enhance accountability and transparency within dental care organizations and prepaid limited health service organizations. The bill seeks to address ongoing issues related to the timely processing of claims and the communication of claim denials to consumers.

One of the key provisions of Assembly Bill 52 mandates that dental care organizations must pay approved claims within 60 working days of receipt. Failure to comply may result in administrative fines imposed by the Commissioner of Insurance. If non-compliance persists, the Commissioner has the authority to suspend or revoke the organization’s certificate of authority. This provision is designed to protect consumers from delays in receiving benefits and to ensure that dental care organizations adhere to established timelines.

Additionally, the bill requires these organizations to submit annual compliance reports to the Commissioner, detailing the number of claims that did not meet the required standards and the total interest paid on delayed claims. This reporting requirement aims to foster greater oversight and accountability in the industry.

Another significant aspect of the bill pertains to the notification process for denied claims. If a prepaid limited health service organization denies a claim, it must inform the claimant in writing within 21 days for electronically submitted information or 30 days for non-electronic submissions. The notice must clearly outline the reasons for the denial, including specific facts and the criteria used to evaluate the claim. This provision is intended to enhance transparency and help consumers understand the basis for claim decisions.

The introduction of Assembly Bill 52 has sparked discussions among stakeholders. Proponents argue that the bill is a necessary step toward protecting consumers and ensuring fair practices in the dental care industry. Critics, however, express concerns about the potential administrative burden on organizations and the implications for operational costs, which could ultimately affect service delivery.

The bill's passage could have significant implications for the dental care landscape in Nevada, potentially leading to improved consumer trust and satisfaction. As the legislative process unfolds, stakeholders will be closely monitoring the debates and any amendments that may arise, as these could shape the final form of the bill and its impact on the industry.