LCO No. 1554 1 of 2
General Assembly Proposed Bill No. 5278
January Session, 2025
LCO No. 1554
Referred to Committee on INSURANCE AND REAL ESTATE
Introduced by:
REP. TURCO, 27th Dist.
AN ACT PROHIBITING HEALTH CARE INSURERS FROM
RETROACTIVELY DENYING HEALTH INSURANCE CLAIMS FOR
BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
That title 38a of the general statutes be amended to limit health care 1
insurers from retroactively denying health insurance claims and 2
clawing back payments for behavioral health and substance abuse 3
services: (1) After one year from the date of such service when prior 4
authorization for such service was issued and the health care provider 5
was paid for such service; and (2) when the health care insurer fails to 6
provide written notice and an explanation of retroactive denial of the 7
claim to the health care provider for such service within one year from 8
the date of such service, except that health care insurers are exempt from 9
such retroactive denial and clawback of claims limitations where any 10
such heath insurance claim is based on fraudulent activity or such 11
service was not delivered. 12 Proposed Bill No. 5278
LCO No. 1554 2 of 2
Statement of Purpose:
To limit health care insurers from retroactively denying health
insurance claims and clawing back payments for behavioral health and
substance abuse services: (1) After one year from the date of such service
when prior authorization for such service was issued and the health care
provider was paid for such service; and (2) when the health care insurer
fails to provide written notice and an explanation of retroactive denial
of the claim to the health care provider for such service within one year
from the date of such service, except that health care insurers are exempt
from such retroactive denial and clawback of claims limitations where
any such heath insurance claim is based on fraudulent activity or such
service was not delivered.