Who can I contact if a prior authorization, or a payment for medical services is denied by my insurance carrier, or is less than you think it should be?
It may be helpful to contact your healthcare provider first to request assistance. Their staff can be helpful in assessing if the issue may be due to missing or incorrect information. For example, your insurance carrier may require additional clinical information from the physician to approve a procedure, or a billing code error may have triggered a claim denial.
If your provider’s office cannot help you resolve the issue, contact your insurance carrier directly. Ask for a detailed explanation of their decision.
If you still do not understand or agree with your carrier’s decision, request instructions on how to file an appeal. If your health insurance is provided through your employer, you can also ask your company’s benefits coordinator for assistance.
Additional resources:
Connecticut Office of the Healthcare Advocate Online Inquiry Form.
The Office of the Healthcare Advocate (OHA) provides free assistance for Connecticut Residents or members of insurance plans sited in Connecticut. OHA will assist with health plan selection, as well as direct advocacy with appeals of a healthcare plan's denial of a claim or service. If you've had a service denied and would like to appeal or would simply like information about your rights and options, you can complete this form and they will contact you.
Contact the Connecticut Insurance Department
The Connecticut Insurance Department offers a Consumer Affairs Helpline to help you with questions about your insurance and also provides information on how to file a complaint.
You may also contact the Office of Health Strategy at 860-418-7001 or OHS@CT.gov for assistance.