OHA: Three Step Complaint Process

Coverage Problems

Three Step Complaint Process

Health plans and agencies that oversee health plans have formal procedures for you to follow if you have a problem. The following represents the general procedure, but it may vary depending on your particular managed care health plan.

  • Make sure the service is not excluded in your health plan contract
  • Appeal "internally" to your insurer first; Connecticut State law requires that your appeal is to be reviewed and resolved within 15 days from the date you submitted the request for appeal, unless an extension is granted for an additional 15 days
  • Obtain a written denial from your plan's internal appeals process
  • File for an external appeal with the State of Connecticut within 120 days (or through your carrier if you have the right to an external review through a self-funded plan)

For more detailed explanation, click on . . .

Step One Step Two Step Three