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 that the statute permits an insurer to deduct the insured's cost share before reimbursing an out-of-network provider. The court further held that cost sharing is calculated using the insured's in-network deductible, copayment, or coinsurance applied to the statutory reimbursement amount, not to a hypothetical in-network service rate.