(a) As used in this Code section, the term "general anesthesia"
means the use of an anesthetic that is complete and affects the
entire body, causing loss of consciousness when the anesthetic acts
upon the brain. Such anesthetics are usually administered
intravenously or through inhalation. (b)(1) Any individual or group plan, policy, or contract for
health care services which is issued, delivered, issued for
delivery, or renewed in this state by a health care insurer,
health maintenance organization, accident and sickness insurer,
fraternal benefit society, nonprofit hospital service corporation,
nonprofit medical service corporation, health care plan, or any
other person, firm, corporation, joint venture, or other similar
business entity that pays for, purchases, or furnishes health care
services to patients, insureds, or beneficiaries in this state
shall be subject to the provisions of this Code section. (2) Any entity listed in paragraph (1) of this subsection and
located or domiciled outside of this state shall be subject to the
provisions of this Code section if it receives, processes,
adjudicates, pays, or denies any claim for health care services
submitted by or on behalf of any patient, insured, or other
beneficiary who resides or receives health care services in this
state. (c) Any entity that provides a health care services plan, policy, or
contract subject to this Code section shall provide coverage for
general anesthesia and associated hospital or ambulatory surgical
facility charges in conjunction with dental care provided to a
person insured or otherwise covered under such plan if such person
is: (1) Seven years of age or younger or is developmentally disabled; (2) An individual for which a successful result cannot be expected
from dental care provided under local anesthesia because of a
neurological or other medically compromising condition of the
insured; or (3) An individual who has sustained extensive facial or dental
trauma, unless otherwise covered by workers' compensation
insurance. (d) Any entity that provides a health care services plan, policy, or
contract subject to this Code section may require prior
authorization for general anesthesia and associated hospital or
ambulatory surgical facility charges for dental care in the same
manner that prior authorization is required for such benefits in
connection with other covered medical care. (e) Any entity that provides a health care services plan, policy, or
contract subject to this Code section may restrict coverage under
this Code section to include only procedures performed by: (1) A fully accredited specialist in pediatric dentistry or other
dentist fully accredited in a recognized dental specialty for
which hospital or ambulatory surgical facility privileges are
granted;
(2) A dentist who is certified by virtue of completion of an
accredited program of postgraduate training to be granted hospital
or ambulatory surgical facility privileges; or (3) A dentist who has not yet satisfied certification requirements
but has been granted hospital or ambulatory surgical facility
privileges. (f) This Code section shall not apply to limited benefit insurance policies as defined in paragraph (4) of subsection (e) of Code Section 33-30-12. |