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HB 5278

AN ACT PROHIBITING HEALTH CARE INSURERS FROM RETROACTIVELY DENYING HEALTH INSURANCE CLAIMS FOR BEHAVIORAL HEALTH AND SUBSTANCE ABUSE SERVICES.

2025 Regular Session Introduced by Gary Turco

Connecticut bill prohibits insurers from retroactively denying behavioral health and substance abuse claims after services are delivered, protecting patients from unexpected medical debt.

REF. TO JOINT COMM. ON Insurance and Real Estate
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Bill Summary · HB 5278

Legislative bill overview

HB 5278 would prohibit health insurance companies from retroactively denying claims for behavioral health and substance abuse services after those services have already been provided. The bill aims to protect patients from unexpected financial liability when insurers later determine they will not cover previously rendered mental health or addiction treatment services.

Why is this important

Retroactive claim denials can leave patients with substantial unexpected medical debt and create barriers to seeking critical mental health and addiction treatment. This protection is particularly significant for vulnerable populations struggling with substance abuse or mental illness, who may delay or avoid treatment due to fear of unexpected bills, and it aligns with efforts to expand access to behavioral health care.

Potential points of contention

  • Insurance industry costs: Insurers may argue the bill limits their ability to manage fraud, verify eligibility, or deny coverage for services that didn't meet medical necessity standards, potentially increasing premiums
  • Coverage determination timing: Questions remain about when coverage determinations should occur—at point of service, during treatment, or after—and who bears responsibility for verifying coverage upfront
  • Scope ambiguity: The bill's language may need clarification on whether it applies to all behavioral health denials or only specific categories, and how it interacts with existing utilization review processes

Compiled from official sources — confirm details with the bill’s official record.

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