(a) For purposes of this section:

(1) “Request payment” includes, but is not limited to, submitting a bill for services not actually owed or submitting for such services an invoice or other communication detailing the cost of the services that is not clearly marked with the phrase “This is not a bill”.

(2) “Health care provider” means a person licensed to provide health care services under chapters 370 to 373, inclusive, chapters 375 to 383b, inclusive, chapters 384a to 384c, inclusive, or chapter 400j.

(3) “Enrollee” means a person who has contracted for or who participates in a health care plan for such enrollee or such enrollee's eligible dependents.

(4) “Coinsurance, copayment, deductible or other out-of-pocket expense” means the portion of a charge for services covered by a health care plan that, under the plan's terms, it is the obligation of the enrollee to pay.

(5) “Health care plan” has the same meaning as provided in subsection (a) of section 38a-477aa.

(6) “Health carrier” has the same meaning as provided in subsection (a) of section 38a-477aa.

(7) “Emergency services” has the same meaning as provided in subsection (a) of section 38a-477aa.

(b) It shall be an unfair trade practice in violation of chapter 735a for any health care provider to request payment from an enrollee, other than a coinsurance, copayment, deductible or other out-of-pocket expense, for (1) health care services or a facility fee, as defined in section 19a-508c, covered under a health care plan, (2) emergency services covered under a health care plan and rendered by an out-of-network health care provider, or (3) a surprise bill, as defined in section 38a-477aa.

(c) It shall be an unfair trade practice in violation of chapter 735a for any health care provider to report to a credit reporting agency an enrollee's failure to pay a bill for the services, facility fee or surprise bill as set forth in subsection (b) of this section, when a health carrier has primary responsibility for payment of such services, fees or bills.

(P.A. 98-163, S. 1; P.A. 15-118, S. 26; 15-146, S. 11.)

History: (Revisor's note: In 2003, a reference in Subsec. (a)(2) to “chapters 370 to 373, inclusive” was erroneously changed editorially by the Revisors to “this chapter, chapters 371 to 373, inclusive”; in 2013, the Revisors restored the original reference in Subsec. (a)(2) to “chapters 370 to 373, inclusive”, as enacted in P.A. 98-163, S. 1, in order to correct their 2003 editorial error); P.A. 15-118 made a technical change in Subsec. (a)(4); P.A. 15-146 amended Subsec. (a) by deleting definition of “managed care organization”, changing “copayment or deductible” to “coinsurance, copayment, deductible or other out-of-pocket expense” and adding definitions of “health care plan”, “health carrier” and “emergency services”, amended Subsec. (b) by adding as unfair trade practice a health care provider request for payment by enrollee of facility fee covered under health care plan, emergency services covered under health care plan and rendered by out-of-network health care provider or surprise bill, amended Subsec. (c) by adding as unfair trade practice the reporting by health care provider of enrollee to credit reporting agency for failure to pay facility fee or surprise bill for which health carrier has primary responsibility for payment, and made technical and conforming changes, effective July 1, 2016.

Prohibitions on balance billing in Subsec. (b) apply only to health care providers in contractual relationship with an enrollee's managed care plan, and not to providers who are “out-of-network”. 142 CA 641.