Connecticut Billing Rights
Additional State-Law Protections for Patients with State-Regulated Health Plans
Connecticut passed its own NSA law in 2015 that requires health carriers (e.g., insurers and HMOs) regulated by the Department of Insurance to (1) bill covered persons (e.g., insureds) at the in-network level for services rendered that resulted in a surprise bill and (2) provide them notice about surprise bills in policy documents and on the carriers’ websites. Surprise bills are generally those that are unexpected and charged by providers who are not in the carriers’ networks. The law prohibits health care providers from requesting payment, except for a copayment, deductible, coinsurance, or other out-of-pocket expense, from an insured for a surprise bill. In Connecticut, a “surprise bill” is a bill for non-emergency health care services received by an insured for services rendered by the following:
- an out-of-network clinical laboratory if the insured was referred by an in-network provider or
- an out-of-network provider at an in-network facility during a service or procedure that was performed by an in-network provider or previously approved by the health carrier, and the insured did not knowingly elect to receive the services from the out-of-network provider.
A bill is not a surprise bill if an in-network provider is available but an insured knowingly elects to receive services from an out-of-network provider.
Filing a Complaint
The Connecticut Insurance Department intends to continue its responsibilities and commitment to protect consumers, including receiving complaints from consumers on issues related to the NSA and Connecticut Surprise Billing laws. These complaints may concern health plans and health care providers and facilities and may be referred, as appropriate, to other state or federal agencies for investigation and enforcement. Contact the Insurance Department’s Consumer Affairs Division to File a Complaint or Ask a Question at https://portal.ct.gov/cid/file-a-complaint?language=en_US.
State Agency Contact Information
Connecticut Insurance Department’s Consumer Affairs Division
Phone: 800-203-3447 or 860-297-3900
Website: portal.ct.gov/cid
Additional Information
More information on that state law is available at Conn. Gen. Stat. §§ 38a-477aa and 20-7f or the Connecticut Department of Insurance website at https://portal.ct.gov/cid/knowledge-base/articles/no-surprice-act.
Visit www.cms.gov/nosurprises/consumers or call 800-985-3059 for more information about your rights under federal law.