Vermont prompt-pay law for dental claims

Does it apply to dental? Standalone dental excluded

Vermont exempts stand-alone dental outright: "The provisions of this section shall not apply to stand-alone dental plans licensed to do business in Vermont" (§9418(m)), and §9418(a)(3) excludes stand-alone dental plans from the definition of contracting entity. A Vermont dentist billing a stand-alone dental carrier has no §9418 deadline and no §9418 interest — the contract governs. Dental services paid under a medical health plan are inside the section. The broad "health care services" definition that includes dental, at 18 V.S.A. §9408a, is expressly scoped to that section, which governs uniform provider credentialing, not claim payment.

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.