How and When to File an External Review
The Connecticut Insurance Department is here to assist consumers who have been denied coverage or reimbursement for services under their health insurance plans.
Individuals may appeal their denials with their health insurers and if unsuccessful, they have a right to an independent review through the Connecticut Insurance Department’s External Review Program.
Denials that are eligible for this program include medical necessity determinations, continued treatment stays, experimental/investigational denials, eligibility and rescission of coverage.
Health plan members who disagree with the health insurers determinations may file for a Request for External Review with the Connecticut Insurance Department. In most cases, members will need to complete the internal review process through their health plan prior to applying for External Review. For urgent care requests, this requirement can be waived.
The Request for External Review must be submitted within 120 days of the written notification that the internal appeals have been exhausted. For expedited appeals of urgent care requests, members may file immediately after the initial denial notification or following any internal appeal determination.
Effective October 1, 2013, certain Behavioral Health services that have been denied are eligible for an expedited 24 hour determination. See our new updated Consumer Guide and External Review Application below for further information.
For complete information on the External Review Program, please download the following information: