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HB 5172

AN ACT PROHIBITING HEALTH CARE PROVIDERS AND CLINICAL LABORATORIES FROM IMPOSING OUT-OF-POCKET EXPENSES BASED ON ESTIMATES OF CHARGES.

2025 Regular Session Introduced by Gary Turco

Connecticut bill HB 5172 prevents healthcare providers and labs from billing patients based on estimated charges, requiring instead that final actual charges determine out-of-pocket costs.

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Bill Summary · HB 5172

Legislative bill overview

HB 5172 would prohibit health care providers and clinical laboratories in Connecticut from charging patients out-of-pocket expenses based on estimated charges. Instead, the bill appears to require that actual charges—determined after services are rendered—form the basis for patient billing. This addresses the common practice where patients receive upfront cost estimates that may differ significantly from their final bills.

Why is this important

Medical billing surprises are a major source of financial hardship for patients, particularly those with high-deductible insurance plans or without insurance. By preventing billing based on estimates, this bill aims to reduce unexpected charges and improve price transparency. However, the practical implementation raises questions about how providers would handle billing before final claim adjudication, which can take weeks or months.

Potential points of contention

  • Cash flow impact on providers: Healthcare providers rely on timely payment; delaying out-of-pocket collection until actual charges are known could create cash flow problems, particularly for smaller practices and labs
  • Insurance claim uncertainty: Final charges depend partly on insurance claim processing and negotiated rates, which aren't finalized when services are rendered—creating ambiguity about when "actual" charges become known
  • Scope and definitions: The bill's language regarding which expenses are covered and how it applies to different scenarios (emergency care, multiple-step procedures, insurance denials) may need clarification

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

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