Connecticut House Bill HB05453

Connecticut 2023 Regular Session

• Introduced: 1/17/23
• Refer: 1/17/23

Caption

An Act Prohibiting Health Care Insurers From Retroactively Denying Health Insurance Claims For Behavioral Health And Substance Abuse Services.

Impact

The enactment of HB 05453 would significantly strengthen the rights of both healthcare providers and patients in the behavioral health and substance abuse sectors. By preventing insurers from making retroactive denials, the bill would add a level of certainty and stability for healthcare providers who treat patients in these vital areas. This change is aimed at encouraging providers to offer necessary services without the fear of potential future payment clawbacks, which could deter them from providing treatment in the first place.

Summary

House Bill 05453, proposed in January 2023, aims to protect clients seeking behavioral health and substance abuse services by prohibiting health care insurers from retroactively denying insurance claims for these services. Specifically, the bill stipulates that if a health care provider has been paid for a service following prior authorization, the insurer cannot claw back payments after one year from the service date. Furthermore, if an insurer wants to deny a claim retroactively, they must provide written notice and an explanation of the denial within one year from the date of the service.

Contention

Discussions surrounding the bill suggest that there may be contention among insurance companies about the potential financial implications of this legislation. Opponents argue that this bill could lead to increased costs for insurers and, consequently, higher premiums for consumers. However, advocates contend that the bill addresses a pressing need for reliable patient care and that the protection of patients’ access to necessary treatment outweighs concerns regarding potential cost increases.