Connecticut 2025 Regular Session

Connecticut House Bill HB05278 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	LCO No. 1554 1 of 2
4	4
5	5	General Assembly Proposed Bill No. 5278
6	6	January Session, 2025
7	7	LCO No. 1554
8	8
9	9
10	10	Referred to Committee on INSURANCE AND REAL ESTATE
11	11
12	12
13	13	Introduced by:
14	14	REP. TURCO, 27th Dist.
15	15
16	16
17	17
18	18	AN ACT PROHIBITING HEALTH CARE INSURERS FROM
19	19	RETROACTIVELY DENYING HEALTH INSURANCE CLAIMS FOR
20	20	BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES.
21	21	Be it enacted by the Senate and House of Representatives in General
22	22	Assembly convened:
23	23
24	24	That title 38a of the general statutes be amended to limit health care 1
25	25	insurers from retroactively denying health insurance claims and 2
26	26	clawing back payments for behavioral health and substance abuse 3
27	27	services: (1) After one year from the date of such service when prior 4
28	28	authorization for such service was issued and the health care provider 5
29	29	was paid for such service; and (2) when the health care insurer fails to 6
30	30	provide written notice and an explanation of retroactive denial of the 7
31	31	claim to the health care provider for such service within one year from 8
32	32	the date of such service, except that health care insurers are exempt from 9
33	33	such retroactive denial and clawback of claims limitations where any 10
34	34	such heath insurance claim is based on fraudulent activity or such 11
35	35	service was not delivered. 12 Proposed Bill No. 5278
36	36
37	37
38	38	LCO No. 1554 2 of 2
39	39
40	40	Statement of Purpose:
41	41	To limit health care insurers from retroactively denying health
42	42	insurance claims and clawing back payments for behavioral health and
43	43	substance abuse services: (1) After one year from the date of such service
44	44	when prior authorization for such service was issued and the health care
45	45	provider was paid for such service; and (2) when the health care insurer
46	46	fails to provide written notice and an explanation of retroactive denial
47	47	of the claim to the health care provider for such service within one year
48	48	from the date of such service, except that health care insurers are exempt
49	49	from such retroactive denial and clawback of claims limitations where
50	50	any such heath insurance claim is based on fraudulent activity or such
51	51	service was not delivered.