HB 7039, An Act Concerning Health Insurance

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE INSURANCE AND REAL ESTATE COMMITTEE

Thursday, February 27, 2025

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning HB 7039, An Act Concerning Health Insurance. CHA supports Sections 1 and 10 of the bill.

Connecticut hospitals and health systems care for patients, strengthen the state’s economy, and support vulnerable communities across the state. Every day, they work to improve healthcare access, affordability, and health equity. Even as they face ongoing challenges, hospitals provide world-class care to everyone who walks through their doors, regardless of their ability to pay. Hospitals also support an exemplary workforce as the largest collective employer in the state, contribute significantly to the state’s economy, and invest in their communities addressing social drivers of health.

Section 1 of the bill would prohibit health insurers from retroactively denying or recouping payment for claims for mental health and substance use disorder services after two years from the date of such service, and when an insurer fails to provide written notice and an explanation of a retroactive denial or recoupment of payment no later than one year from the date of service.

Burdensome insurance practices, such as recouping payment or denying claims years past service dates, remain significant barriers to healthcare delivery. These practices add unnecessary costs and add uncertainty for patients and providers alike. CHA has long advocated for action regarding payer behaviors that jeopardize timely care and appropriate payment. These include excessive prior authorization requirements, delays, inefficiencies, post-payment audits, and downcoding, which continue to pose challenges to patients and healthcare providers.

While we appreciate the step this legislation takes to address one such detrimental practice, we encourage the Committee to go further and ensure that payment recoupment or claims denial for all services, not just those for mental health and substance use disorders, are addressed by the legislation.

We also support Section 10 of the legislation which would make appropriate adjustments to the definition of “clinical peer” for purposes of how utilization reviews are conducted by health insurers. While we believe the utilization review process should be improved generally, we appreciate that this language will improve the functioning of the current process.

Thank you for your consideration of our position. For additional information, contact CHA Government Relations at (203) 294-7301.