What is prior authorization?
Prior authorization (PA) means the carrier must approve certain care before it happens. A PA denial is different from a claim denial after care was provided.
Overview for any state: Prior authorizations. This page is Connecticut-only.
Confirm plan type: Connecticut: Start Here.
Connecticut PA deadlines
Connecticut's utilization review law is Conn. Gen. Stat. § 38a-591d. Prescription drug PA follows additional carrier and pharmacy benefit manager rules—check your denial notice.
Medical services (non-urgent)
- Prospective or concurrent review: determination within 7 calendar days after the carrier receives the request
- Retrospective (after care): within 30 calendar days
- Carriers must acknowledge receipt of non-urgent prospective/concurrent requests within 24 hours
- Approved PA generally must stay effective at least 60 days (consumer guidance and industry materials; confirm on your authorization notice)
Urgent care
- Determination as soon as possible, but not later than 24 hours after receipt (when the carrier has needed information)
- If more information is needed, the carrier must ask within 24 hours; you generally have at least 48 hours to respond; final notice within 48 hours after information is received
- Substance use disorder and certain mental health level-of-care requests are treated as urgent automatically under Connecticut law
If the carrier misses deadlines
If a health carrier fails to strictly follow § 38a-591d, you may be treated as having exhausted internal grievance and can request external review—even if the carrier claims a minor error (§ 38a-591d(g)). Document dates and save all notices.
Revoking an approval
Carriers generally cannot reverse PA and refuse payment for a scheduled service without at least 3 business days notice before the service date (when PA was already relied on).
Clinical peer conference
After an initial medical-necessity denial on a prospective or concurrent request, your clinician may request a conference with a clinical peer at the carrier before filing a formal grievance—that conference is not the same as a grievance unless one is filed (§ 38a-591d(a)(3)).
Where to look up PA rules
Match tools to the exact plan on the ID card. Major 2026 Access Health CT carriers:
- Anthem Blue Cross Blue Shield: anthem.com/connecticut
- ConnectiCare: connecticare.com
- Aetna / CVS, UnitedHealthcare, Oxford — common on employer plans; use member portals on the card
State overview: Connecticut OHA — Prior authorization.
HUSKY Health
HUSKY (Medicaid/CHIP) PA follows DSS and managed care organization rules. Prior authorization deemed granted within 24 hours applies to certain DSS pharmacy programs (§ 17b-491a)—not private commercial insurance.
Service denials: appeal to the plan, then DSS administrative hearing—often 60 days from the Notice of Action (huskyhealthct.org).
If PA is denied
- Get the adverse determination in writing with specific clinical reasons and grievance instructions.
- Ask the treating clinician for records and a medical-necessity letter.
- Consider a clinical peer conference if offered, then file a grievance within 180 days if still denied.
- See Connecticut internal appeals.
Building a strong appeal packet has a checklist.
Urgent care
Use the 24-hour urgent UR rules above. Urgent cases may qualify for immediate external review after a denial without waiting for full internal appeal (CID — External Review). See Connecticut external review and expedited appeals.