Bill > SB01210

This bill requires health carriers (insurance companies) to pay a civil penalty when an independent review organization (IRO) overturns their adverse determination during an external review process. Specifically, when a health carrier's initial decision to deny, limit, or delay a healthcare service or treatment is reversed by an independent third-party review organization, the carrier will be required to pay a monetary penalty. This penalty will be deposited into the Insurance Fund and then allocated to the Office of the Healthcare Advocate, which helps protect and support consumers in healthcare-related matters. The bill amends section 38a-591g of the general statutes to implement this new requirement, seemingly as a way to discourage health carriers from making inappropriate or unsupported coverage denials and to provide additional resources to an advocacy office that supports healthcare consumers.

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https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=SB01210&which_year=2025