2005 Connecticut Code - Sec. 19a-509a. Audits of hospital bills. Charges.
Sec. 19a-509a. Audits of hospital bills. Charges. (a) No hospital shall charge
payers which are health insurance plans or insurance arrangements issued to or in accordance with a trust established pursuant to collective bargaining subject to the federal
Labor Management Relations Act, a fee for an audit to verify that charges are correct
and that services were actually performed, provided the amount of the charges is ten
thousand dollars or more and one hundred per cent of the charges, excluding any applicable coinsurance and deductibles, is paid on or before the tenth business day after receipt
of the bill by the payer in accordance with the terms of the patient's health insurance
coverage agreement. If the amount of the charges is less than ten thousand dollars and one
hundred per cent of the charges, excluding any applicable coinsurance and deductibles, is
paid on or before the tenth business day after receipt of the bill by the payer, a fee, not
to exceed two per cent of the amount of the total bill, may be charged for the audit.
(c) If a dispute arises which the parties are unable to resolve within thirty days of the receipt of the audit findings, the dispute shall be immediately submitted to arbitration to be conducted by the American Arbitration Association. The cost of arbitration shall be borne equally by the parties to the dispute.
(d) When an audit request is submitted in accordance with an agreement between the hospital and the payer or the provisions of subsection (a), the hospital shall not issue, in any form, bills to the patient, nor initiate self-pay collection efforts until the audit is complete and the charges are determined to be correct either by mutual agreement of the parties or arbitration. If a balance is due to the hospital and it is not paid within twenty days, collection efforts may be initiated.
(e) As used in this section "hospital" means a hospital included within the definition of health care facilities or institutions under section 19a-630 and licensed as a short-term general hospital by the Department of Public Health, including John Dempsey Hospital of The University of Connecticut Health Center.
(P.A. 91-267; P.A. 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 93-381 replaced department of health services with department of public health and addiction services, effective July 1, 1993; P.A. 95-257 replaced Commissioner and Department of Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995.
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