Connecticut House Bill HB06612

Connecticut 2013 Regular Session

• Introduced: 3/7/13
• Refer: 3/7/13
• Report Pass: 3/19/13
• Refer: 3/28/13
• Report Pass: 4/4/13

Caption

An Act Concerning The Health Insurance Grievance Process For Adverse Determinations, The Office Of The Healthcare Advocate And Mental Health Parity Compliance Checks.

Impact

The implications of HB 6612 on state laws include strengthened regulations regarding how health insurance companies must conduct their grievance processes. By requiring health carriers to establish comprehensive procedures and maintain records for adverse determinations, the bill aims to protect consumers. It is designed to prevent delays in obtaining necessary medical services while holding insurers accountable for timely communication of their decisions. The legislature anticipates that these improvements will reduce consumer confusion and potentially lower the volume of disputes requiring external review.

Summary

House Bill 6612 addresses the grievance process related to adverse determinations made by health insurance carriers. This legislation aims to enhance transparency and efficiency in how health insurance companies handle appeals related to denied medical services. It specifies timeframes within which health carriers must make determinations regarding urgent care requests, ensuring that individuals receive timely responses to their healthcare needs. The bill emphasizes the importance of expedited review processes for urgent situations and mandates that health carriers communicate decisions effectively to covered persons and their representatives.

Sentiment

The general sentiment surrounding HB 6612 appears to be positive among proponents, who view the bill as a significant step toward consumer protection in healthcare. They argue that the bill will enhance patient rights and promote accountability among health insurance companies. However, some concerns have been raised regarding the feasibility of implementation and the potential administrative burden on smaller health carriers. This division suggests a need for balanced dialogue around the practical aspects of the new requirements.

Contention

Notable points of contention include debates over the efficiency of existing grievance processes and whether the regulations introduced by HB 6612 adequately address systemic issues in health insurance claims management. Critics have argued that while the bill seeks to provide clarity and protection, it may not sufficiently respond to the complexities of mental health parity compliance and the longstanding issues surrounding insurance approvals. The bill's effectiveness will ultimately depend on how well health insurance companies adapt to these regulatory changes.