How to appeal a health insurance denial in Connecticut
The short answer
Start with your plan’s own appeal. If the plan says no again, you can usually ask an independent reviewer to decide. Connecticut lets you ask an independent reviewer to decide, through Connecticut Insurance Department. The deadline to ask: within 120 days of the written notification that the internal appeals have been exhausted.
Does this apply to you? State external review covers plans regulated by Connecticut: individual and Marketplace plans, and job-based plans your employer bought from an insurer. Many large employers are self-funded; their plans follow the federal external review process, and state law usually does not apply (29 CFR 2590.715-2719(c)(1)). Medicare, Medicaid, TRICARE and federal employee plans have their own appeals: see the plan guides.
External review in Connecticut
Within 120 days of the written notification that the internal appeals have been exhausted
Expedited decisions: 48 hours for most urgent requests (72 hours if the 48-hour period falls on a weekend), 24 hours for behavioral health or substance use cases, and 5 days for experimental/investigational cases. Urgent requests may be filed immediately after any denial without finishing the plan's internal appeals; a provider signs the Physician Certification Form (behavioral health and substance abuse requests are expedited automatically).
Free (the former $25 filing fee was eliminated October 1, 2021)
Fully insured plans issued in Connecticut and the State of Connecticut employee plan. Self-funded employer plans use the federal process.
Send the Request for External Review form, a copy of your insurance ID card and the final denial letter directly to the Insurance Department (externalreview@ct.gov, fax 860-297-3872, or P.O. Box 816, Hartford, CT 06142-0816); the Department assigns an independent review organization. Eligible denials include medical necessity, continued stays, experimental/investigational, eligibility and rescission; denials of services your plan does not cover at all are not eligible. Consumer Affairs: 860-297-3900 or toll-free 800-203-3447; the external review unit is 860-297-3910.
Who to contact
- Connecticut Insurance Department
- External review information and forms
- Consumer help line: 800-203-3447
Before external review: the internal appeal
External review usually comes after your plan’s own appeal. The deadline for that first appeal depends on the type of plan:
- Employer plan: 180 days from the day you receive the denial notice
- Marketplace plan: 180 days from the day you receive the denial notice
- Medicare Advantage: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Medicare Part D: 60 days from when you receive the denial (counted as 65 days from the notice date)
- Original Medicare: 120 days from when you receive the notice (counted as 125 days from the notice date)
- Medicaid: 60 days from the date printed on the denial notice
- FEHB (federal employees): 6 months from the date of the denial notice
- TRICARE: Mail within 90 days after the date of the denial notice
Questions people ask
How long do I have to ask for an external review in Connecticut?
Within 120 days of the written notification that the internal appeals have been exhausted
Can I get a fast external review in Connecticut?
Expedited decisions: 48 hours for most urgent requests (72 hours if the 48-hour period falls on a weekend), 24 hours for behavioral health or substance use cases, and 5 days for experimental/investigational cases. Urgent requests may be filed immediately after any denial without finishing the plan's internal appeals; a provider signs the Physician Certification Form (behavioral health and substance abuse requests are expedited automatically).
Does external review cost anything in Connecticut?
Free (the former $25 filing fee was eliminated October 1, 2021)
Do Connecticut’s rules apply to my job-based plan?
Only if the plan is fully insured, meaning your employer bought a policy from an insurance company. Self-funded employer plans generally follow the federal external review process instead. Your Summary Plan Description or HR benefits team can tell you which kind you have.
Sources
- Connecticut Insurance Department: External Review
The Request for External Review must be submitted within 120 days of the written notification that the internal appeals have been exhausted.
- Connecticut Insurance Department: Notice of External Review Changes effective October 1, 2021
Conn. Gen. Stat. § 38a-591g has been revised to eliminate the consumer fee of twenty-five dollars for External Review applications.
- Connecticut Insurance Department: External Review Program - Frequently Asked Questions
All Other Expedited Requests – 48 Hours*
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.