State guide
Connecticut
Pick the kind of plan you have to see who to call first. Connecticut can only help with plans it regulates.
Which plan do you have? Who to call first, by coverage
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Your employer pays claims itself
Connecticut usually cannot help with these plans. Call the Employee Benefits Security Administration.
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Insurance you buy, or an employer plan bought from an insurer
Call Connecticut Insurance Department. See the at-a-glance box.
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Medicaid or children's coverage
Call the number on your notice and ask to appeal, and to keep services going while you appeal. The hearing deadline is under Medicaid in Connecticut.
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Medicare
CHOICES (Connecticut's program for Health Insurance Assistance, Outreach, Information and Referral, Counseling, and Eligibility Screening) gives free counseling. Or call 1-800-MEDICARE.
The short version for Connecticut
Connecticut has an unusually strong free helper: the Office of the Healthcare Advocate, a state agency whose staff will prepare and file appeals for you, and whose contact details state law requires insurers to print on the first page of every denial letter. External review is run by the Connecticut Insurance Department, costs nothing, and must be requested within 120 days of the insurer's final denial. Denials of mental health and substance use treatment get especially fast handling, with some expedited external reviews decided in 24 hours.
At a glance: independent review for plans Connecticut regulates
- Main regulator
- Connecticut Insurance Department · (800) 203-3447 or (860) 297-3900
- Independent review
- A state process (External Review Program (external review by an Independent Review Organization))
- Deadline to request it
- 120 days after the insurer's written notice that your internal appeals are exhausted (the final determination letter). For urgent care requests you may file immediately after any denial.
- Cost
- None. Connecticut eliminated its $25 filing fee effective October 1, 2021.
- Decision time
- 45 days (20 days when the denial was for experimental or investigational treatment); fast track: 48 hours for most expedited requests (72 hours if the 48-hour period falls on a weekend); 24 hours for behavioral health or substance use; 5 days for expedited experimental or investigational reviews
Who regulates health plans
The Connecticut Insurance Department does not give an insurance-card tip. It says the state external review program covers only fully insured plans issued in Connecticut and the State of Connecticut employee plan, and that your claims administrator (the company named on your card) can tell you whether your plan is self-insured and, if so, direct you to the review options under your plan. When you file a complaint, the department checks whether your plan falls under Connecticut jurisdiction and refers you elsewhere if it does not.
- Connecticut Insurance Department
Fully insured health plans issued in Connecticut (individual and employer group policies bought from an insurance company or health maintenance organization). It does not regulate self-insured employer plans, where the employer pays claims itself, Medicare, or HUSKY Health (Medicaid).
Phone: (800) 203-3447 or (860) 297-3900. File a complaint online
Independent (external) review
- Process
- A state process. Run by Connecticut Insurance Department, which assigns each case to one of the independent review organizations it contracts with.
- Where you file
- regulator
- How
- Send the completed and signed Request for External Review form, a copy of your insurance card and a copy of the insurer's final denial letter to the Connecticut Insurance Department, Attn: External Review, P.O. Box 816, Hartford CT 06142-0816, or by email to insurance@ct.gov. For an expedited review, also include the Physician Certification Form signed by your doctor (not needed for behavioral health or substance use denials). Questions: 860-297-3910.
- Which denials qualify
- Denials based on medical necessity (including continued stays and level of care), experimental or investigational treatment, eligibility, rescission (cancellation) of coverage, or refusal of an in-network exception for an out-of-network provider. The service must be one your plan covers: denials because a benefit is simply not covered under the contract are not eligible. The plan must be fully insured and issued in Connecticut, or the State of Connecticut employee plan; self-insured plans are not included.
- Appeal to the plan first?
- Yes. You must complete the insurer's mandatory internal appeals and have a final determination letter. This is waived for urgent care requests, which can go to external review immediately after any insurer denial; requests about substance use or behavioral health treatment are automatically handled as expedited. Expedited review is not available if you have already received the service.
- Published results
- The Connecticut Insurance Department says that historically nearly 40% of all denials are overturned through the program (stated in its frequently asked questions guide dated August 2022; no year-by-year figure is given). Source
Free help in Connecticut
- Connecticut Office of the Healthcare Advocate (OHA)
A free state agency whose advocates explain your benefits and prepare and file appeals of denials and prior authorization refusals for you, including external review, for any kind of coverage (employer, individual, Medicare, HUSKY Health); phones are staffed Monday through Friday, 8:00 a.m. to 4:30 p.m., and email (Healthcare.Advocate@ct.gov) is often quickest.
Phone: 1-866-466-4446
- Statewide Legal Services of Connecticut
Free legal advice and referrals for people with very low income on public benefits problems; the Department of Social Services lists this number for legal help with HUSKY Health (Medicaid) hearings.
Phone: 1-800-453-3320
Medicare and Medicaid in Connecticut
- Medicare counseling
- CHOICES (Connecticut's program for Health Insurance Assistance, Outreach, Information and Referral, Counseling, and Eligibility Screening) · 1-800-994-9422 . Free help with Medicare appeals.
- Medicaid agency
- Connecticut Department of Social Services (HUSKY Health)
- Fair hearing deadline
- 60 days from the date of the Department of Social Services Notice of Action. Your notice states the deadline that applies to you.
- Good to know
- For HUSKY Health (Medicaid), your benefits can continue during the hearing if you ask for the hearing before the date the proposed action takes effect. The best way to ask is the Hearing Request Form attached to the notice; questions about hearings go to 1-800-462-0134. The Office of the Healthcare Advocate also helps HUSKY Health members.
State laws that can help
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Denial notice. Since January 1, 2023, every denial and appeal-denial notice must show on its first page or cover sheet a state-approved message telling you to contact the Office of the Healthcare Advocate for free help with an appeal.
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Step therapy. An insurer cannot make you stay on a step therapy drug (a cheaper drug you must try first) for longer than 30 days, cannot require step therapy at all for certain conditions such as stage IV metastatic cancer, multiple sclerosis, rheumatoid arthritis, schizophrenia, major depressive disorder or bipolar disorder, and must quickly grant an override when your provider shows the required drug has failed, is expected to fail, would likely harm you, or is not in your best interest.
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Prior authorization. Insurers must decide urgent prior authorization requests within 24 hours (requests for higher levels of mental health or substance use care are automatically urgent) and non-urgent requests within 7 calendar days, approvals must stay valid for at least 60 days, and you can ask for a doctor-to-doctor conference before appealing.
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Surprise billing. For a surprise bill from an out-of-network provider at an in-network facility, or for out-of-network emergency care, you owe only what you would have paid in-network, and insurers cannot require prior authorization for emergency services.
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Mental health parity. Insurers may not apply limits such as prior authorization to mental health and substance use benefits more strictly than to medical and surgical benefits, and must prove it in a yearly report to the Connecticut Insurance Department, which announced enforcement actions against five carriers in April 2026.
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External review. External review is free to request, covers eligibility and rescission disputes as well as medical necessity, and the reviewer's decision is final and binding on the insurer.
Sources and what we could not confirm
- Centers for Medicare & Medicaid Services: State External Appeals Review Processes
- Connecticut Insurance Department: How And When To File An External Review
- Connecticut Insurance Department: External Review Program Frequently Asked Questions (August 2022)
- Connecticut Insurance Department: Notice of External Review Changes effective October 1, 2021
- Connecticut Insurance Department: Ask a Question or File a Complaint
- Connecticut Insurance Department: The CID Complaint Process
- Connecticut Insurance Department home page
- Connecticut Insurance Department press release, April 22, 2026 (parity report and enforcement)
- Office of the Healthcare Advocate
- Office of the Healthcare Advocate: Laws about Adverse Determination Notices
- Office of the Healthcare Advocate: Prior Authorization
- Centers for Medicare & Medicaid Services: Connecticut Consumer Assistance
- Connecticut Aging and Disability Services: CHOICES
- State Health Insurance Assistance Programs: Connecticut
- Connecticut Department of Social Services: Requesting A Hearing
- Connecticut Department of Social Services: Fair Hearing notice and request form (W-0534)
- Statewide Legal Services of Connecticut
- Connecticut General Statutes, Chapter 700c (Health Insurance)
- Connecticut General Statutes section 38a-510 (Justia copy, 2025 edition)
- Connecticut General Statutes section 38a-477aa (Justia copy, 2025 edition)
Not confirmed (13)
- How long a fast independent review takes. the Insurance Department's August 2022 guide says 48 hours (72 if the period falls on a weekend) and 24 hours for behavioral health; the Office of the Healthcare Advocate's appeal article, per this project's earlier research, says 72 hours. The department's figures are used.
- The independent review request form. the link is listed on the department's external review page and responds, but the current form itself was not opened. An old copy (revised 10/1/13) still circulating on a third-party site asks for a $25 fee that was eliminated on October 1, 2021; do not use it.
- Published results of independent review. 'nearly 40%' is an undated historical figure from an August 2022 guide; no annual statistics page was found.
- A searchable list of past decisions. no searchable database of past external review decisions was found, so null.
- How to file for independent review. the guide gives insurance@ct.gov for filing by email while an older form gives externalreview@ct.gov; the department's street address changed to 280 Trumbull Street, 7th Floor, Hartford in September 2026, but the guide and the federal contact page still show 153 Market Street. The P.O. Box is the address given for filing.
- The state regulators. the department prints three numbers: (860) 297-3900 and (800) 203-3447 for consumer help, (860) 297-3800 as its general line, and 860-297-3910 for external review questions.
- The state regulators. the landing page was loaded; the online complaint form it leads to (hosted by the National Association of Insurance Commissioners) was seen only through the search index.
- How to tell whether the state regulates your plan. no official insurance-card tip was found; the text restates the department's eligibility and complaint-process wording.
- Notes on Medicaid appeals. no current official page was found describing a separate appeal step with a HUSKY Health administrator before the state hearing; an older legislative flyer describing health plan appeals predates the current program and was not used.
- Not confirmed. stateLaws (prior-authorization) — timeframes are from the Office of the Healthcare Advocate's article, which does not cite a statute section; section 38a-591d is this file's attribution and the statute text was not read.
- Not confirmed. stateLaws (step-therapy, surprise-billing) — statute text was read on Justia's 2025 edition and in search extracts of the legislature's Chapter 700c page; the '#sec_' anchors in the URLs were not individually tested. A 2025 amendment (Public Act 25-94) added multiple sclerosis and rheumatoid arthritis effective January 1, 2026.
- Not confirmed. stateLaws (ai-in-utilization-review, gold card) — no Connecticut law on these topics was researched or confirmed.
- Free consumer help programs. the Connecticut Attorney General's office was not checked for a health insurance complaint unit.