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 does not independently support a CUTPA claim when the conduct is not also identified as an unfair insurance practice under CUIPA, and it interpreted the surprise billing law to permit insurers to deduct the insured's applicable cost share from payments to providers. The court further held that the insured's in-network cost-sharing obligations apply to the allowable amount for the out-of-network emergency services, rather than to a hypothetical in-network rate.