What laws govern adverse determination notices?
Sections 71-73, inclusive, of Public Act 22-47 (PDF), An Act Concerning Children’s Mental Health, made amendments to sections of the Insurance Statutes (specifically, Conn. Gen. Stat. §38a-591d, 38a-591e, and §38a-591f). The amendments, which became effective on January 1, 2023, require certain information on adverse determination notices to be prominently displayed on the notice’s first page or cover sheet and that such language be approved by the Office of the Healthcare Advocate (OHA).
The Connecticut Insurance Department will advise all health insurance companies, health care centers, hospital service corporations, and medical service corporations that OHA, consistent with Public Act 22-47 (PDF), has published on its website the following approved language, revised October 2025:
For initial adverse determinations (C.G.S. §38a-591d) and for appeal denials (C.G.S. §38a-591e & §38a-591f)
| A Message from the State of CT Office of the Healthcare Advocate (OHA): Read this letter carefully, it contains an insurance denial. Contact your insurance plan if you have questions about how they made this decision. If you disagree and you want to appeal, contact OHA for free help at healthcare.advocate@ct.gov or (866)466-4446. Visit us at www.ct.gov/OHA |