The Connecticut legislature approved a sweeping health insurance transparency measure. Here’s what it will do.

Jun. 22--Tucked deep within the newly approved state budget is a far-reaching provision that aims to protect patients from unexpected medical bills and improve transparency in the health care industry.

The measure, which is expected to be signed into law by Gov. Ned Lamont, is the product of bipartisan cooperation between Senate President Pro Tem Martin Looney, a Democrat from New Haven, and the chamber's Republican leader, Len Fasano of North Haven.

"This was one of the most significant consumer protection combinations we did this year," Looney said. "It will provide relief and protections for consumers in Connecticut and it puts us ahead of the curve nationally."

Fasano noted that the measure is the latest in a series of policy changes that strive to protect patients from unexpected financial burden of medical costs not covered by insurance.

Stay up to date on Connecticut politics. Subscribe to the Capitol Watch newsletter here

"It's a consumer-oriented bill," Fasano said. "This is [part of] what Sen. Looney and I started maybe four years ago, with tryng to get more transparency in medical billing and prescription drugs. Every year, we try to isolate issues we're hearing about."

This year's effort to boost cost transparency in healthcare started as a series of proposals that were rolled into one bill. That measure passed the Senate nearly unanimously; Sen. Rob Sampson cast the lone no vote. But the bill died before coming up for a vote in the House of Representatives so lawmakers rolled its provisions into the state budget package.

So what will the measure do?

Add laboratories to the list of providers barred from levying surprise medical bills

About one in every six emergency room visits or hospital stays resulted in at least one unexpected out-of-network medical bill in 2017, according to study by the Kaiser Family Foundation. That's because, in an emergency situation, patients can be treated physicians and other providers who are out of their insurance network, even if they using an in-network hospital or were referred by an in-network physician.

Congress is currently grappling with the issue on the federal level; President Trump has voiced support for efforts in Congress to end surprise medical bills.

Connecticut has prohibited surprise medical billing since 2016 but clinical laboratories that analyze blood and tissue samples were not included in that prohibition. The measure approved this year extends the ban on surprise bills to laboratory services.

Provide greater scrutiny of hospital "trauma-activation fees"

This provision seeks to provide greater oversight of "trauma-activation" fees, charges collected by hospitals when they activate trauma physicians and other emergency personnel to deal with a serious emergency. Those fees can sometimes amount to $10,000 and are currently unregulated, Looney said.

Under the measure, hospitals will have to send a report to the state Office of Health Strategy each time they impose a trauma-activation fee.

Establish a "prudent layperson standard" for insurance coverage

When someone experiences a symptom of a potentially life-threatening illness, the message is clear: seek emergency medical help.

But what if, after a series of expensive medical tests, that squeezing in your chest turns out to be a bad case of indigestion and not a heart attack? Some insurers have sought to deny coverage when a patient makes an "inappropriate" visit to an emergency room.

Under this provision, insurers must cover the cost of treating a medical condition that a "prudent layperson, acting reasonably, would believe" constitutes an emergency."

Create a task force to study high-deductible health insurance plans

The measure approved by the legislature establishes a task force to study the impact of high-deductible health insurance plans. The panel will be charged with looking at the financial impact of such plans on Connecticut families. It will also examine the use of health care savings accounts.

The task force is required to issue a report to lawmakers before the start of the 2020 legislative session.

___

(c)2019 The Hartford Courant (Hartford, Conn.)

Visit The Hartford Courant (Hartford, Conn.) at www.courant.com

Distributed by Tribune Content Agency, LLC.