Effective July 1, 2016, a “surprise bill” from an out-of-network healthcare provider may be considered an unfair trade practice in Connecticut. The state’s new bipartisan omnibus healthcare bill (SB 811) provides for penalties under the state’s unfair trade practices law if a healthcare provider issues a “surprise bill.”
The new legislation, passed by both the State Senate and House as of June 2, is officially named "An Act Concerning Parity in Hospital Sales Oversight" but includes a number of significant pro-consumer provisions. The Act defines a “surprise bill” as a “bill for health care services, other than emergency services, received by an insured for services rendered by an out-of-network health care provider, where such services were rendered by such out-of-network provider at an in-network facility, during a service or procedure performed by an in-network provider or during a service or procedure previously approved or authorized by the health carrier and the insured did not knowingly elect to obtain such services from such out-of-network provider.” The insured may knowingly elect to obtain services from an out-of-network provider, in which case the bill for the services will not be considered a “surprise bill.”
Under the new law, requesting payment for a surprise bill or reporting an individual to a credit reporting agency for failure to pay a surprise bill will be considered a violation of Connecticut’s unfair trade practice law and subject the provider to investigation and/or prosecution, punitive damages, and civil penalties. Therefore, before making a referral, a provider will need to be cognizant of whether his or her colleagues are in-network, and an out-of-network provider will need to document the insured’s consent before providing care and proceed accordingly.