Did Connecticut's 2008 prompt-payment law cover out-of-state doctors treating Connecticut residents?

Plain-English summary

In 2008, Connecticut's Insurance Department asked whether the state's insurer prompt-payment statute protected out-of-state health care providers who treated Connecticut residents. The Attorney General did not settle the question. He found the statute could be read in two ways and recommended that lawmakers clarify whether it covered providers licensed elsewhere.

The department had interpreted the statute to cover both in-state and out-of-state providers. A 2001 amendment expanded the categories of covered medical professionals, supporting a broad reading. But the amendment also referred to a person "licensed to provide health care services" under Connecticut's listed licensing chapters, which could imply a Connecticut license was required. The AG said both readings were plausible.

Currency note

This opinion was issued in 2008. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Out-of-state health care providers at the time

The opinion did not establish that the 2008 prompt-payment and interest provisions covered providers licensed in another state. It said the department's inclusive interpretation was reasonable in light of the amendment's purpose, but acknowledged that the text could limit coverage to Connecticut-licensed providers.

Health insurers and insurance officials at the time

The AG described the department's interpretation and the statutory interest charge for late insurer payments, then stopped short of endorsing one reading as controlling. His recommendation to the commissioner was to "seek legislative clarification" of the statute's reach.

Legislators at the time

The opinion asked for clarification of whether protections applied to providers licensed in Connecticut and other states who delivered the covered kinds of care to Connecticut residents. It treated that question as unresolved by the amendment's wording and legislative history.

Common questions

Q: Did the 2008 AG opinion say out-of-state providers definitely received Connecticut prompt-payment protections?
A: No. It found the inclusive reading reasonable but identified text that could support a Connecticut-license limitation and sought legislative clarification.

Q: Why was the statute ambiguous?
A: The 2001 amendment expanded the types of providers covered, but defined them with a reference to people licensed under Connecticut health-care licensing chapters. The AG said those features pointed in different directions on out-of-state licenses.

Q: What had the Insurance Department been doing?
A: The opinion said the department had interpreted the statute to require timely payment to both Connecticut and out-of-state providers serving Connecticut residents. The AG described that practice without giving a conclusive legal answer.

Background and statutory framework

Conn. Gen. Stat. § 38a-816(15) required timely insurer payment to covered providers and provided an interest charge for late bills. Public Act 01-111 added a definition of "health care provider" intended to expand the professional categories protected. The commissioner asked whether that definition also reached a provider licensed outside Connecticut.

The AG noted both the department's inclusive practice and the possible narrower reading of "person licensed" under Connecticut statutes. He concluded that lawmakers, rather than the opinion, should resolve the ambiguity.

Citations and references

Statute and act cited in the opinion: Conn. Gen. Stat. § 38a-816(15); Public Act 01-111.

Source

• Landing page: https://portal.ct.gov/AG/Opinions
• Opinion page: https://portal.ct.gov/ag/opinions/2008-formal-opinions/honorable-thomas-r-sullivan-insurance-commissioner-formal-opinion-2008015-attorney-general-state-of

Original opinion text

Honorable Thomas R. Sullivan, Insurance Commissioner, Formal Opinion 2008-015, Attorney General State of Connecticut

Attorney General's Opinion

Attorney General, Richard Blumenthal

September 22, 2008

Honorable Thomas R. Sullivan

Insurance Commissioner

State of Connecticut

P.O. Box 816

Hartford, CT 06142-0816

Dear Commissioner Sullivan:

You have asked for our opinion on whether the provisions of Conn. Gen. Stat. § 38a -816(15) apply to out-of-state health care providers who provide health care to Connecticut residents. That statute requires health insurance companies to make timely payment to health care providers and imposes a fifteen per cent late charge on bills that are not timely paid. It is my opinion that you should seek legislative clarification of this issue because past legislative amendments to Section 38a-816(15) can be interpreted to both expand and limit the scope of that statute's protection.

According to the information supplied by your Department, the Insurance Department has interpreted Conn. Gen. Stat. § 38a-816(15) to require insurance companies to make timely payment to Connecticut and out-of-state health care providers who provide health services to Connecticut residents. Any insurance company that fails to make timely payment as set forth in the statute is required to pay interest "at the rate of fifteen per cent per annum."

Prior to 2001, there was no definition of "health care provider" contained in Section 38a-816(15). In 2001, the General Assembly enacted Public Act 01-111 amending Conn. Gen. Stat. § 38a-816(15) to define the term "health care provider" to include those categories of health care services contained in "chapter 368v, chapters 370 to 373, inclusive, 375 to 383c, inclusive, or chapter 400j." Public Act 01-111. That definition was codified as Conn. Gen. Stat. § 38a-816(15)(C). The new definition of "health care provider" substantially expanded the categories of health care providers who would be covered by the timely payment and interest provisions of Section 38a-816(15). According to its legislative history, Public Act 01-111 was intended "to expand the definition of medical providers so it is no longer just physicians but a number of medical providers…." H. Rep., at 4680(May 29,2001)(remarks of Rep. Cleary); see also S. Rep., at 1754 (remarks of Sen. Harp)("We haven't defined health care provider and this bill defines health care provider and specifies which providers are (sic), for the purposes of prompt payment claims, will be included.")

Although Public Act 01-111 expanded the categories of health care providers covered by Section 38a-816(15), the Public Act included within the definition of health care provider the words "person licensed to provide health care services" under the cited Connecticut licensing statutes. The question has now been raised whether Conn. Gen. Stat. § 38a-816(15) only applies to health care providers who are licensed in Connecticut or whether it also applies to health care providers within the categories of health care providers set forth in Section 38a-816(15)(C) who are licensed in other states .

Your Department had construed Section 38a-816(15) as applying to in-state and out-of-state health care providers. Because the legislature through Public Act 01-111 intended to expand the categories of health care providers protected by Section 38a-816(15), it is reasonable to believe that the legislature did not intend Public Act 01-111 to limit the provisions of that statute to health care providers licensed in Connecticut. Nevertheless, Section 381-816(15)(C) can be read to provide such a limitation.

I recommend that you seek legislative clarification of whether Public Act 01-111 intended the protections afforded by Section 38a-816(15) to apply to health care providers licensed in Connecticut and other states who provide Connecticut residents the types of health care services set forth in Section 38a-816(15)(C).

Clearly, there are strong public policy reasons for ensuring that all health care providers who provide health care services to Connecticut residents receive timely payment for their services. I would be pleased to work with you on this matter.

Very truly yours,

RICHARD BLUMENTHAL

ATTORNEY GENERAL