Louisiana prompt-pay law for dental claims

Does it apply to dental? Standalone dental excluded

Stand-alone dental is outside the Subpart. The definition of "health insurance coverage" the prompt-pay sections ride on excludes benefits provided under a separate policy, certificate, or contract of insurance for "limited scope dental or vision benefits" (R.S. 22:1831(13)). Dentists do fit the provider definition, so dental services billed under comprehensive medical coverage are inside the 25- and 45-day rules — but a claim to a separate dental plan, which is how most dental insurance is written, is not. Also outside: ERISA-preempted employee benefit plans (R.S. 22:1831(14)) and the Office of Group Benefits (R.S. 22:1832(D), 22:1833(E)).

Self-funded (ERISA) plans: A self-funded private-employer (ERISA) dental plan is generally beyond a state prompt-pay statute's reach: 29 U.S.C. § 1144(b)(2)(B) bars a state from deeming such a plan an insurer, and the courts have read that to keep state insurance regulation off it. The statute itself never uses the words self-funded or prompt pay, and the rule is not categorical — a self-funded governmental or church plan is not an ERISA plan at all, so state law can reach it; § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law; and nothing in § 1144 addresses state enforcement against the third-party administrator or the network contract. Where the plan is a self-funded ERISA group health plan, the federal claims-procedure deadlines apply instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.