Connecticut insurance appeal rights
Connecticut's Insurance Department oversees a robust state external-review program and active consumer assistance through the Office of the Healthcare Advocate (OHA).
Internal appeal rights
Internal appeal: 180 days. Response 30 days standard, 72 hours urgent.
External review
Connecticut external review is administered through state-certified IROs and binds the carrier.
CT regulator
Connecticut Insurance Department. official site
Notable
- Office of the Healthcare Advocate: 866-466-4446, free help with appeals.
- Connecticut enforces mental health parity actively and publishes carrier-specific compliance data.
How to file an external review in Connecticut
In Connecticut, external review is run by the state itself, not the federal HHS process. The Connecticut Insurance Department administers the External Review Program under Connecticut General Statutes Section 38a-591g, and an independent review organization, not your insurer, makes the call. You generally must finish your plan's internal appeals first, then file a Request for External Review with the Department within 120 days of your final internal denial. If a delay would seriously jeopardize your health, an expedited review is available and can be decided within roughly 72 hours, sometimes without exhausting internal appeals. The reviewer's decision is binding on the insurer, and the review is free to you.
Connecticut appeal questions
How do I file for external review in Connecticut?
Complete the Request for External Review (External Review Application) available from the Connecticut Insurance Department and submit it to the Department after your health plan's internal appeals are exhausted. The Department conducts a preliminary eligibility check, then assigns your case to an independent review organization. You can reach the Consumer Helpline at 860-297-3900 or email insurance@ct.gov for help completing the form.
What is the deadline to request external review in Connecticut?
You have 120 days from the date you receive your final internal adverse determination to file the request, as set out in Connecticut General Statutes Section 38a-591g. Missing this window can forfeit your right to external review, so file as soon as your internal appeal is denied. For urgent medical situations, you may request an expedited review immediately, sometimes before internal appeals are finished.
Does external review cost anything in Connecticut?
No. The Connecticut Insurance Department's External Review Program is free to consumers, and the cost of the independent review organization is borne by the insurer, not you. There is no filing fee to submit your Request for External Review. This means you can pursue an independent decision without out-of-pocket expense.
Is the external review decision binding, and does it cover all plans?
Yes, the independent reviewer's decision is binding on the insurer, and if the reviewer overturns the denial the plan must provide the coverage. The reviewer weighs medical necessity and whether the denial followed your plan's terms and applicable standards. Note that many self-funded employer plans are governed by federal ERISA law and may use the federal HHS-administered external review instead of Connecticut's program, so check your plan documents or ask the Insurance Department which path applies.
Filed a denial in Connecticut?
We work under CT rules and structure the appeal under the strongest available state and federal protections.
Start Your AppealState law information is provided for general guidance and is not legal advice. Confirm with your state regulator or a licensed attorney for your specific case.