How and When to File an External Appeal
External Appeal Consumer Guide (PDF 100 kb) – Details eligibility requirements and the process of filing an external appeal with the Insurance Department.
Connecticut General Statutes §38a-478n allows a health plan member to request an external appeal if the health plan denies benefits because they disagree that a medical service or procedure is or was medically necessary. The process can be initiated only after the plan member exhausts all internal appeals with their health plan.
External Appeal Request forms must be submitted within 60 days of the date the member received notice that all internal appeals have concluded.
Download a Request for External Appeal form (PDF - Portable Document Format)( RTF - Rich Text Format)
Requests for external appeal are forwarded to an external appeal entity. The entity then identifies and contracts with a specialist in the field of medicine that is the subject of the appeal to review the appeal request.
Pursuant to CGS§38a-478n, the Connecticut Insurance Commissioner must accept the final decision of the external appeal entity.
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Content Last Modified on 9/16/2009 12:28:07 PM
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