New to helping someone in Connecticut?
Start with three things from the patient or family:
- Insurance card — shows the carrier and plan name
- Denial letter or explanation of benefits (EOB) — lists appeal rights and deadlines
- Summary of Benefits and Coverage (SBC) — if available
Your first job is to learn what kind of plan this is (Marketplace, job-based, Medicaid, Medicare) and what deadline the letter gives you. Connecticut plans often use adverse determination, grievance, and external review.
For steps that work in every state, use these general guides first, then return here for Connecticut rules:
What is different in Connecticut?
- Access Health CT: Connecticut's state-based Marketplace at accesshealthct.com (Anthem, ConnectiCare Benefits, and ConnectiCare Insurance Company for 2026 individual QHPs—not HealthCare.gov for enrollment).
- Connecticut Insurance Department (CID): Regulates most fully insured commercial health plans and runs a binding External Review Program (Conn. Gen. Stat. § 38a-591g).
- Prior authorization timelines: Many non-urgent requests must be decided within 7 calendar days; urgent within 24 hours; missing UR deadlines can let you skip to external review (§ 38a-591d).
- External review: File within 120 days of final internal denial; standard decision in 45 days, expedited often 72 hours (behavioral health expedited reviews can be faster).
- HUSKY Health (Medicaid): Plan appeal plus DSS administrative hearing—separate from CID external review.
Who is in charge of your plan?
- Connecticut Insurance Department: Fully insured health plans, external review — portal.ct.gov/cid. Consumer line: 800-203-3447 or 860-297-3900.
- U.S. Department of Labor: Many self-funded employer plans.
- Department of Social Services (DSS): HUSKY appeals and administrative hearings — huskyhealthct.org.
- CMS: Medicare and Medicare Advantage.
For complaints after appeals, see Regulator complaints.