Sec. 38a-542e. Cancer clinical trials: Billing. Payments. Appeals.
Sec. 38a-542e. Cancer clinical trials: Billing. Payments. Appeals. (a) Providers,
hospitals and institutions that provide routine patient care services as set forth in subsection (a) of section 38a-542d as part of a cancer clinical trial that meets the requirements
of sections 38a-542a to 38a-542g, inclusive, and is approved for coverage by the insurer
or health care center shall not bill the insurer or health care center or the insured person
for any facility, ancillary or professional services or costs that are not routine patient
care services as set forth in subsection (a) of section 38a-542d or for any product or
service that is paid by the entity sponsoring or funding the cancer clinical trial.
(b) Providers, hospitals, institutions and insured persons may appeal a health plan's
denials of payment for services only to the extent permitted by the contract between the
insurer or health care center and the provider, hospital or institution.
(c) Providers, hospitals or institutions that have contracts with the insurer or health
care center to render covered routine patient care services to insured persons as part of
a cancer clinical trial may not bill the insured person for the cost of any covered routine
patient care service.
(d) Providers, hospitals or institutions that do not have a contract with the insurer
or health care center to render covered routine patient care services to insured persons
as part of a cancer clinical trial may not bill the insured person for the cost of any covered
routine patient care service.
(e) Nothing in this section shall be construed to prohibit a provider, hospital or
institution from collecting a deductible or copayment as set forth in the insured person's
contract for any covered routine patient care service.
(f) Pursuant to subsection (b) of section 38a-542d, insurers or health care centers
shall be required to pay providers, hospitals and institutions that do not have a contract
with the insurer or health care center to render covered routine patient care services to
insured persons the lesser of (1) the lowest contracted per diem, fee schedule rate or
case rate that the insurer or health care center pays to any participating provider in the
state of Connecticut for similar in-network services, or (2) the billed charges. Providers,
hospitals or institutions may not collect any amount more than the total amount paid by
the insurer or health care center and the insured person in the form of a deductible or
copayment set forth in the insured person's contract. Such amount shall be deemed by
the provider, hospital or institution to be payment in full.
(P.A. 01-171, S. 5, 25.)
History: P.A. 01-171 effective January 1, 2002.
See Sec. 38a-504e for similar provisions re individual policies.