Connecticut law requires insurers to list full fee schedule

The legislation limits how often insurers can make changes to a contract with a physician and sets an 18-month limit on retroactive claim denials.

By Emily Berry — Posted July 31, 2009

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A bill just signed into law in Connecticut makes insurers subject to rules that the state medical society called "one of the most progressive contracting laws in the country."

The new law requires plans to make available a fee schedule listing every CPT code relevant to a physician's specialty, and to make it accessible online. That requirement takes effect in January 2010.

According to AMA research cited by the Connecticut State Medical Society, just five states require insurers to disclose a physician's entire fee schedule, and even some of those limit the number of accessible codes.

"It does put us ahead of most states," said CSMS President William H. Handelman, MD, a nephrologist from Torrington, Conn. "In most states there really are no provisions like this."

Current law requires insurers to share only what it will pay a network physician for the 50 codes under Current Procedural Terminology that the doctor will bill most often. But for some specialists who might perform certain costly procedures infrequently, knowing what they will be paid for their care is vitally important to their practice, Dr. Handelman said.

The CSMS lobbied for the changes for several years. Dr. Handelman said the AMA helped the state society get the bill passed by providing legal analysis that laid out for lawmakers how the bill compared to laws in other states.

New limits on changes to contracts and on retroactive claims denials take effect in July. That part of the law limits to 18 months the health plan's ability to reclaim a payment it made in error. Plans also must notify physicians of changes to contracts and won't be able to change contracts substantially more than once a year unless certain exceptions apply.

The law requires the insurer to notify the physician before deducting the claim amount from future payments or asking for repayment, which no other state specifically demands.

WellPoint subsidiary Anthem Blue Cross and Blue Shield in Connecticut, one of the state's dominant insurers, was pleased that the bill was signed, spokeswoman Sarah Yeager wrote in an e-mailed statement.

"This model legislation reflects one of Anthem's key goals of promoting fair and open communications with the physicians who participate in our networks," the statement said.

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