Connecticut House Bill HB05278

Connecticut 2025 Regular Session

• Introduced: 1/15/25
• Refer: 1/15/25

Caption

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

Impact

The impact of HB 05278 could be significant for how health care insurers operate in Connecticut. By enforcing these restrictions, the bill is likely to reduce the frequency of claim denial practices that have been a source of frustration for health care providers. It encourages timely communication between insurers and providers, potentially leading to improved care continuity for patients requiring behavioral health and substance abuse interventions.

Summary

House Bill 05278 aims to prohibit health care insurers from retroactively denying health insurance claims specifically for behavioral health and substance abuse services. This legislation intends to provide greater security for health care providers and patients by safeguarding them against unexpected denial of claims after services have been rendered and payments made. The bill specifies that a retroactive denial can only occur if the health care insurer notifies the provider within one year of the service date and if prior authorization had not been previously issued.

Conclusion

Ultimately, the passage of HB 05278 could mark a pivotal change in state law governing health care reimbursement practices. It reflects a growing acknowledgment of the importance of mental health services and the stability needed for both patients and providers in the face of insurance operations. Stakeholder engagement and discussions in legislative sessions will likely shape the final form of the bill as it moves through the legislative process.

Contention

Notably, the bill recognizes exemptions where health care insurers can still retroactively deny claims, specifically in cases of fraud or when services were not delivered. This aspect of the bill could lead to discussions among stakeholders regarding the balance between preventing undue financial burdens on providers and maintaining oversight against fraud. Such provisions might attract diverse opinions among insurers, healthcare advocates, and legislators regarding the practicalities of enforcement and compliance.