What is the Montana prompt-pay deadline for dental claims, and what interest applies to late payment?

Under Mont. Code Ann. §33-18-232; §33-18-231; §33-18-233, the Montana payment deadline is 30 days (no format split). A non-compliant insurer liable on the claim owes the claim plus 10% annual interest from the date the claim was due (day 30, or day 60 after an information request) — but only when the computed interest exceeds $5 (§33-18-232(2)). Dental applicability: Dental reach is entity-dependent, and only one of the three answers is settled. A self-funded private-employer (ERISA) plan is generally beyond this statute's reach and runs on the federal claims-procedure clock instead — but that comes from the courts reading 29 U.S.C. § 1144, not from its text, and it is not categorical: a self-funded governmental or church plan is not an ERISA plan at all, § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law, and nothing in § 1144 bars a state from reaching the third-party administrator or the network contract.

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Dental covered, with caveats · Last verified 2026-08-31

Montana prompt-pay law for dental claims

Montana's prompt-pay law reaches dental claims with caveats. Clean claims must be paid or denied within 30 days; late payment accrues statutory interest.

Mont. Code Ann. §33-18-232; §33-18-231; §33-18-233

Read the statute text

Payment deadlines

Electronic claims: 30 days (no format split)
Paper claims: 30 days (no format split)

Insurers must pay or deny within 30 days after receipt of proof of loss — extended to 60 days from the original receipt when the insurer makes a reasonable request for additional information. Montana draws no electronic-vs-paper distinction; the statute keys the clock to "proof of loss," defined format-neutrally. The 60-day limit is not a hard ceiling: it is lifted where the insurer notifies the insured, the insured's assignee, or the claimant of the reasons for failure to pay in full, or where the insurer has a reasonable belief of insurance fraud and has reported it to the commissioner (§33-18-232(1)). Those escapes suspend the duty but do not move the interest accrual date, which §33-18-232(2) fixes at day 30 or day 60.

Interest and penalties

A non-compliant insurer liable on the claim owes the claim plus 10% annual interest from the date the claim was due (day 30, or day 60 after an information request) — but only when the computed interest exceeds $5 (§33-18-232(2)). The $25,000 figure that circulates is not in this section: it is the Commissioner's general administrative fine (§33-1-317), available after a hearing for insurers that fail to pay timely as a general course of business (§33-18-233).

Does it apply to dental? Dental covered, with caveats

Dental reach is entity-dependent, and only one of the three answers is settled. The clean hook is the health service corporation: §33-30-102(1) applies Title 33 chapters 1, 10, 12, 15, 18, 19, 22 and 32 to health service corporations, and §33-30-101(2) defines "health services" to include services "by doctors of medicine, osteopathy, dentistry, chiropractic, optometry, and podiatry" — so a Montana health service corporation paying dental claims is squarely inside this section. A stand-alone dental carrier's status is unsettled: §33-18-231(2)'s "insurer" sweeps in any entity that "promises to pay medical benefits in any form," which cuts toward inclusion, but "medical benefits" is undefined in §33-18-231, in Title 33 chapter 1, and anywhere in Part 2, the word "dental" appears nowhere in §§33-18-231 through -235, and Montana has no dental-specific prompt-pay statute and no stand-alone-dental carve-out. A dental HMO sits in an express textual conflict rather than a one-way omission: §33-18-231(2) names "health maintenance organization" in the very definition driving §§33-18-232 and -233, while §33-31-111(1) provides that "the insurance or health service corporation laws do not apply to a health maintenance organization" except as that chapter provides, and its (6)–(7) inclusion lists reach no part of chapter 18 Part 2. No source read resolves either side. There is no Montana "dental service corporation" as a statutory entity — do not look for one. Check with the Commissioner of Securities and Insurance before asserting the rule against a stand-alone dental carrier or a dental HMO.

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.

Estimate the late-payment interest

Uses the verified Montana rule (Mont. Code Ann. §33-18-232; §33-18-231; §33-18-233). Estimate only — the statute's own accrual triggers control.

Claim amount (allowed)Interest statutes run on the payable claim amount, not billed charges.Days past the deadlineDays after the statutory deadline for this claim (30 days (no format split)), not days since submission.

Estimated interest

$10.48

10% per year (simple)

Payable only if the interest due on the claim exceeds $5; paid to whoever receives the claim payment.

How we calculate this

Formula: claim × 10% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from Mont. Code Ann. §33-18-232; §33-18-231; §33-18-233, read against the statute text linked in the sources on this page (last verified 2026-08-31). Accrual start dates, clean-claim status, safe harbors, and plan funding all affect the real figure — treat this as an estimate for the payer conversation, not a demandable amount.

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Also in the statute

The private-action bar is specific, not general: "A private cause of action under 33-18-201 or 33-18-242 may not be based on the compliance or noncompliance with the requirements of this section," and compliance evidence is inadmissible in those actions (§33-18-232(3)). The bar does not on its face reach an ordinary contract action. Enforcement of the section itself runs through the Commissioner.
A safe harbor blocks the administrative fine for insurers that consistently paid 90% of the total dollar amount outstanding in claims to each claimant within 20 working days and all of the amount within 30 working days, during the 6-month period immediately preceding the hearing date (§33-18-233(2)).
Interest payments "must be made to the person who receives the claims payment" (§33-18-232(2)), so an assignee dental practice is the payee — but the enforcement route is still the Commissioner, and the $25,000 fine (§33-1-317) requires a finding of a "general course of business practice" after a hearing (§33-18-233(1)). This is not a per-claim remedy.
Nothing here is indexed: 10% and the $25,000 fine cap are statutory constants, unamended since 2005 and 1993. There is no Montana rate bulletin to look up. Neither is there any contract-override clause or in-network limit in §§33-18-231 through -235 — the statute is silent, and silence is not a carve-out either way.

Sources (statute text)