Nems, Pllc v. Harvard Pilgrim Health Care of Connecticut, Inc.

Summary

The court answered all three certified questions in the negative. It held that a violation of the surprise billing law, standing alone, does not support a CUTPA claim when the conduct is not also identified as an unfair insurance practice under CUIPA; that carriers need not pay providers the insured's cost-sharing portion and then recover it from the insured; and that cost sharing is calculated by applying the insured's in-network policy obligations to the allowable amount for the out-of-network services. The court nevertheless recognized that the plaintiff's allegations could support a CUTPA claim based on specified unfair claim-settlement practices under CUIPA.