What is external review?
External reviewis Connecticut's binding independent review for many health insurance denials. The Connecticut Insurance Department (CID) assigns an approved independent review organization (IRO) that is not your insurance company (Conn. Gen. Stat. §§ 38a-591g–38a-591l).
If the IRO overturns the denial, the carrier must generally provide the service. External review is usually not the first step—see Connecticut internal appeals & grievances.
Background: Appeals roadmap.
When you can use it
Eligible disputes often include:
- Medical necessity
- Experimental or investigational treatment
- Continued stay or course of treatment
- Some eligibility and rescission of coverage determinations
- Certain in-network exception disputes
Pure plan exclusions (benefits never covered) usually cannot be overturned unless a clinician shows the exclusion may not apply.
You can generally request external review when:
- You completed mandatory internal appeals and received a final denial, or
- You are deemed to have exhausted internal review because the carrier missed UR/grievance deadlines (§ 38a-591d(g)), or
- You qualify for urgent external review (see below)
File within 120 days of the final internal denial letter (CID — External Review).
Coverage must be a fully insured plan issued in Connecticut or the state employee health plan. Self-funded ERISA employer plans are generally not eligible.
How to request it (step by step)
- Finish internal grievances unless urgent-care or UR-deadline exceptions apply.
- Gather documents: denial letters, medical records, clinician letter, plan documents.
- Submit a Request for External Review to CID (forms and instructions on the CID website). You may also need to send a copy to your carrier per the form directions.
- Pay the filing fee if required (often $25, with an annual cap for multiple requests—fee may be refunded if you prevail).
- CID assigns an IRO after preliminary review. The IRO reviews records and issues a binding decision.
Resources: portal.ct.gov/cid — External Review · External Review Program FAQs (PDF)
Help: 800-203-3447 or 860-297-3900.
How long it takes
CID-published timelines include:
- Standard medical review: 45 days
- Experimental/investigational: 20 days (standard) or 5 days (expedited)
- Expedited (most urgent cases): 72 hours (or 48 hours, extended to 72 if the period includes a weekend per CID FAQs)
- Expedited behavioral health / substance use: as fast as 24 hours for certain services (post–October 2013 rules)
(§ 38a-591g; CID external review FAQs)
When it does not apply
- Self-funded ERISA employer plans
- Medicare / Medicare Advantage — CMS appeals
- HUSKY / Medicaid — DSS administrative hearing, not CID external review (huskyhealthct.org)
- Benefits your policy never covers (with limited exceptions)
After external review, see Regulator complaints if the carrier does not comply.
Urgent cases
For urgent care requests, you may file external review immediately after an insurance denial—without completing the full internal process first (CID — External Review).
Expedited external review can run concurrently with an expedited internal grievance (§ 38a-591g). Your clinician should document why delay would seriously harm health or function.
For urgent PA, see Connecticut prior authorization law.