What laws govern adverse determination notices?
Sections 71-73, inclusive, of Public Act 22-47 (PDF), An Act Concerning Children’s Mental Health, made amendments to sections of the Insurance Statutes (specifically, Conn. Gen. Stat. §§ 38a-591d, 38a-591e, and 38a-591f). The amendments, which become effective on January 1, 2023, require certain information on adverse determination notices to be prominently displayed on the notice’s first page or cover sheet and that such language be approved by the Office of the Healthcare Advocate (OHA).
The Connecticut Insurance Department has advised all health insurance companies, health care centers, hospital service corporations, and medical service corporations that OHA, consistent with Public Act 22-47 (PDF), has published on its website the following approved language:
For initial adverse determinations (C.G.S. §38a-591d)
This is an insurance DENIAL.
For free help, if you don’t understand this document or want help appealing, contact the State Healthcare Advocate:
866-466-4446 or Healthcare.Advocate@ct.gov
Additional information regarding your appeal rights is available in the section of this notice labeled “[insert applicable section heading]”
For appeal denials (C.G.S. §38a-591e & §38a-591f)
Your insurance appeal has been DENIED.
For free help, if you don’t understand this document or want help appealing further, contact the State Healthcare Advocate:
866-466-4446 or Healthcare.Advocate@ct.gov
Additional information regarding your rights is available in the section of this notice labeled “[insert applicable section heading]”