Noncovered services laws for dental offices
Whether an in-network dental office can charge its full fee for a service the plan doesn't cover: state noncovered services laws and the six states without one.
Checked November 12, 2026
Many network contracts say the office must charge the contracted fee for every service, even ones the plan doesn't pay for. Most states have passed laws that stop dental plans from setting fees for services they don't cover. The ADA reported in March 2026 that 44 states have one.
The six states without one
South Carolina, Delaware, New York, Michigan, Massachusetts and Hawaii have no noncovered services law, according to the ADA. In those states, the network contract decides what you can charge for a service the plan doesn't pay.
Covered isn't the same as paid
In most of these laws, a service is covered if the plan lists it as a benefit, whether or not it pays this time. So when a covered service goes unpaid because a frequency limit, waiting period or yearly maximum was reached, you may still be held to the contracted fee. The law usually frees the fee only for services the plan doesn't cover at all.
- Excluded service, such as implants on a plan with no implant benefit: in most of the 44 states, your own fee.
- Covered service over a frequency limit or after the maximum: often still the contracted fee. Check how your state defines a covered service.
- Any service in the six states without a law: whatever your contract says.
Plans the laws don't reach
State laws apply to plans the state regulates. Many large employers run self-funded plans under federal law instead, and state noncovered services laws may not apply to them. The ADA has backed federal bills to close that gap. Ask the insurer or the patient's employer whether a plan is self-funded.
What to do at the front desk
- Find out which kind of plan the patient has and whether it's state regulated or self-funded.
- Read your network contracts' terms on noncovered services.
- Tell the patient before treatment which fee applies, and get their written agreement to pay.
This is general information, not legal advice. Your state dental society can tell you how your state's law reads and whether it applies to a given plan.
Sources
Read November 11, 2026. Where a source describes one insurer's plans, we say so.
Get the patient's share in dollars, from the benefits page
Every estimate starts with what the plan will pay. Tabruns reads the coverage, deductible, yearly maximum, waiting periods and frequency limits from the insurer's portal and works out what the patient owes. Patient details stay on the office computer.
Not ready? Try the free patient portion calculator.