Connecticut program
Appeal a denial outside the plan (external review)
A free independent review of some insurance denials through the Connecticut Insurance Department.
What it is
A free independent review of some insurance denials through the Connecticut Insurance Department.
A final refusal from the insurer is not always the last word. Connecticut's outside review puts the decision in front of someone outside the plan, and the plan has to follow it. It covers plans Connecticut regulates and the state employee plan; a plan where the employer pays its own claims uses a federal route.
Eligibility rules
- The state route covers Connecticut-issued fully insured plans and expressly includes the Connecticut state employee plan. Other self-insured plans are generally excluded.
What you get
- A free review outside the insurance company.
- A binding decision for an eligible state review.
- A faster review when the urgency rules are met.
What the help covers
- Standard external review generally has a 45-day limit. Urgent review generally uses 48 hours, with a specified weekend extension to 72 hours. Urgent experimental-treatment review can have a five-day limit.
If you decide to apply
- Ask the hospital appeal team or Insurance Department to check the denial and outside-review route.
- Have the denial, final internal-appeal notice and oncology letter ready.
- Ask the care team to explain any medical urgency in the review request.
Connecticut Insurance Department, through an independent reviewer. 860-297-3900 · Official page ↗
After you apply
- CID generally allows 120 days after the applicable final denial. Your clinician and social worker can ask CID whether urgent external review can begin before the internal appeal ends. CID confirms the deadline and route for the particular denial.
Good to know
The 120 days run from the letter ending the plan's own appeals, so keep it. When waiting would harm your child, the urgent review can start before the plan's own appeal is finished.
Other details
- The Insurance Department contact is 860-297-3900. The written notice and plan type determine the next appeal route.
Official sources
“If our plan denies treatment, could an outside reviewer help? What are the deadlines and limits, and could you help us request review if it is appropriate?”
Why I’m asking: I want to understand the next option if an insurer’s decision blocks care.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Discuss the benefit and tradeoffs with the social worker. Ask the hospital appeal team or Insurance Department to check the denial and outside-review route. Have the denial, final internal-appeal notice and oncology letter ready. Ask the care team to explain any medical urgency in the review request.
Your social worker
The oncology team writes the medical case and says whether it is urgent.
The care team
The doctor explains why the treatment is needed and why waiting would harm your child.
- Who decides
- An independent reviewer assigned by the Connecticut Insurance Department; their decision binds the plan.
- Ask the care team
- “If our plan denies treatment, could an outside reviewer help? What are the deadlines and limits, and could you help us request review if it is appropriate?”
How to apply
First step: Your social worker can help you discuss this route and prepare the request if it fits. Ask the hospital appeal team or Insurance Department to check the denial and outside-review route.
- Ask the hospital appeal team or Insurance Department to check the denial and outside-review route.
- Have the denial, final internal-appeal notice and oncology letter ready.
- Ask the care team to explain any medical urgency in the review request.
Official application / program page ↗
Where it starts: CID generally allows 120 days after the applicable final denial. Your clinician and social worker can ask CID whether urgent external review can begin before the internal appeal ends. CID confirms the deadline and route for the particular denial.
What to gather
- The denial letter
- The notice that internal appeals are finished
- The oncology team's letter
How long: Standard external review generally has a 45-day limit. Urgent review generally uses 48 hours, with a specified weekend extension to 72 hours. Urgent experimental-treatment review can have a five-day limit.
Clock: 120 days from the written notice that the plan's own appeals are finished.
What a yes looks like
A written decision overturning the denial, which the plan has to follow.
What a no looks like, and the next move
Ask for the reviewer's reasoning in writing and ask the oncology team whether new evidence changes it.
Watch out
- CID confirms the applicable final-denial trigger and 120-day filing window.
- The state route does not govern every self-funded plan; CID confirms plan eligibility, including the state employee exception.
- Some urgent reviews can begin before internal appeals end. Urgency and the specific decision clock need CID review.
Dates that change this
2026-09-11: The decision clocks below come from a 2022 department FAQ that is still linked. The current statute could not be read, so treat the timings as the department's own published figures rather than freshly confirmed law.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
A free outside review of a denial, within 120 days, with a 48-hour track when the case is urgent.
- $120 — Days to file after internal appeals are finished
- $45 — Standard decision
- $48 — Expedited decision
- $5 — Expedited decision for an experimental or investigational treatment
Legal protection: An independent reviewer's decision binds the plan · The Connecticut state employee plan is expressly included in the department's guidance
What it costs the family: Free.
The eligibility facts, as published
- Age
- any
- Income
- no income test
- Insurance status condition
- a Connecticut-issued fully insured plan, or the Connecticut state employee plan; self-insured plans are generally excluded
- Residency
- Connecticut
- Processing standard
- Generally 45 days standard; 48 hours urgent, with a specified 72-hour weekend extension or five-day urgent experimental-treatment rule.
Decisions this site cannot make: The Insurance Department assigns an independent reviewer
Expect friction on: CID generally allows 120 days after the applicable final denial. Your clinician and social worker can ask CID whether urgent external review can begin before the internal appeal ends. CID confirms the deadline and route for the particular denial.
The trap: The request window generally follows the applicable final denial. Some urgent reviews can begin before internal appeals finish; CID confirms the route for your plan.
Where I read this
- Connecticut Insurance Department — External Review — Connecticut Insurance Department, read September 10, 2026
- Connecticut Insurance Department — External Review FAQ (August 2022, still linked) — Connecticut Insurance Department, read September 10, 2026