CONNECTICUT - BILLING ISSUES

January 1, 2008

State laws and regulations that affect your medical practice

1. Do Connecticut's consumer protection laws apply to physician billing practices?

Yes. While the consumer protection laws do not apply to negligent provision of health care or malpractice, they do apply to the business and entrepreneurial aspects of a medical practice. Fraudulent and deceptive billing practices are therefore actionable under Connecticut's Unfair Trade Practices Act (CUTPA).

C.G.S.A. § 42-110b; Janusauskus v. Fichman, 264 Conn. 796, 809 (2003).

No. In Connecticut, it is considered an unfair trade practice in violation of CUTPA for any health care provider to request payment from an enrollee, other than a copayment or deductible, for medical services covered under a managed care plan.

C.G.S.A. § 20-7f( b )

3. What terms must be included in a written contract between a health care center and a participating provider of health care services?

Every contract between a health care center and a participating provider of health care services shall be in writing and shall set forth that in the event the health care center fails to pay for health care services as set forth in the contract, the subscriber or enrollee shall not be liable to the provider for any sums owed by the health care center.

C.G.S.A. § 38a-193( c )

4. What happens if there is no written prohibition against balance billing in participating provider contracts?

In the event that the participating provider contract has not been reduced to writing or that the contract fails to contain the required prohibition, the participating provider shall not collect or attempt to collect from the subscriber or enrollee sums owed by the health care center.

C.G.S.A. § 38a-193( c )

5. Does a provider have any recourse against a subscriber for sums owed by a health care center?

No. No participating provider may maintain any action at law against a subscriber or enrollee to collect sums owed by a health care center or request payment from a subscriber or enrollee for such sums. The term "request payment" includes, but is not limited to, submitting a bill for services not actually owed or submitting for such services an invoice or other communication detailing the cost of the services that is not clearly marked with the phrase "THIS IS NOT A BILL."

C.G.S.A. § 38a-193( c )

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.