Connecticut Senate Bill SB01210

Connecticut 2025 Regular Session

Caption

An Act Requiring Health Carriers To Pay A Civil Penalty For Adverse Determination Reversals.

Impact

Should SB01210 be enacted, it will amend section 38a-591g of the general statutes, effectively requiring health carriers to compensate for the costs associated with incorrect adverse determinations. The penalties collected from these insurance providers are intended to be deposited into the Insurance Fund, ultimately supporting the Office of the Healthcare Advocate. This measure could lead to improved protection for consumers and ensure that patients have access to necessary treatments that might have initially been denied by their health insurance providers.

Notable

Overall, SB01210 represents a significant effort to enhance the regulatory framework governing health insurance in the state, particularly in how health carriers handle adverse determinations. By introducing civil penalties for incorrect adverse determinations, the bill not only supports the rights of consumers but also reinforces the role of external reviews, potentially shifting the balance in favor of patients seeking healthcare services that have initially been denied.

Summary

SB01210 is a legislative proposal aimed at imposing civil penalties on health carriers when their adverse determinations are overturned through external reviews conducted by independent review organizations. This bill seeks to strengthen accountability among health insurance providers in the state and provide additional support to the Office of the Healthcare Advocate, which assists patients in navigating healthcare disputes and insurance claims. The bill was introduced to the General Assembly by Senator Gadkar-Wilcox and has been referred to the Insurance and Real Estate Committee for further consideration.

Contention

While the bill emphasizes patient rights and accountability within the healthcare system, there may be points of contention among stakeholders. Opponents of the bill may argue that imposing penalties on health carriers could lead to higher insurance premiums as providers adjust their business models in response to increased regulatory scrutiny. Additionally, there may be concerns about the fairness and practicality of determining penalties based on the outcomes of external reviews, potentially leading to litigation or disputes over the assessment of penalties.