What is the average health insurance denial rate in Connecticut?

Health insurers in Connecticut deny approximately 14.8% of ACA marketplace claims, which is 4.3 points below the national average of 19.1%.

How do I appeal a denied insurance claim in Connecticut?

File a written internal appeal with your insurer within 180 days of the denial. If denied again, escalate to an Independent Medical Review (IMR) with the Connecticut Insurance Department. IMRs are free, decided by independent clinicians, and have high success rates.

Which insurance company denies the most claims in Connecticut?

Based on CMS Marketplace Transparency data, the insurers with the highest denial rates in Connecticut are Cigna Healthcare, Aetna (CVS Health), Anthem Blue Cross Blue Shield. See each insurer's full denial report for category-level breakdowns.

What are my rights if my insurance claim is denied in Connecticut?

You have the right to a full written explanation of the denial, an internal appeal, and an external Independent Medical Review with the Connecticut Insurance Department. Federal law requires insurers to respond to standard appeals within 30 days and urgent appeals within 72 hours.

Connecticut Insurance Denial Report

The worst health insurers in Connecticut
by claim denial rate

Connecticut averages a 14.8% denial rate — 4.3 points below the national average. About 130,000 claims are denied annually.

Fight My Denial in Connecticut →

14.8%

Connecticut avg denial rate

19.1%

National average

130,000

Annual denials in state

>80%

Appeals overturned when filed

Health insurance denials in Connecticut

In Connecticut, the average health insurance claim denial rate stands at 14.8%, which is notably lower than the national average of 19.1%. This translates to approximately 130,000 annual denials, highlighting a significant issue that affects many residents seeking necessary medical care. While the state's denial rate is more favorable than the national figure, it still represents a considerable number of individuals facing challenges in accessing their health benefits. Understanding this statistic is crucial for patients as it underscores the importance of being informed about their rights and options when dealing with claim denials.

Patients in Connecticut have the right to appeal any claim denial they encounter. This empowers them to challenge decisions made by their insurance providers. If internal appeals do not yield satisfactory results, patients can escalate their cases to the Connecticut Insurance Department, the regulatory body overseeing insurance practices in the state. This process ensures that individuals are not left without recourse and can take steps to secure the coverage they deserve. Knowing these options can help patients navigate the complexities of health insurance and advocate for their rights effectively.

Worst insurers in Connecticut by denial rate

Source: CMS Marketplace Transparency Report 2023. In-network ACA marketplace claims only.

Cigna Healthcare

33.1% denial rate

Cigna denies 33.1% of claims — 14.0 points above the national average. Their appeal overturn rate is 61%.

GLP-1 Medications: 44% deniedSpecialty Medications: 40% deniedMental Health: 37% denied

Full Cigna denial report →

Aetna (CVS Health)

17.2% denial rate

Aetna denies 17.2% of claims — 1.9 points below the national average. Their appeal overturn rate is 65%.

GLP-1 Medications: 28% deniedSpecialty Medications: 22% deniedMental Health: 18% denied

Full Aetna denial report →

Anthem Blue Cross Blue Shield

18.8% denial rate

Anthem denies 18.8% of claims — 0.3 points below the national average. Their appeal overturn rate is 63%.

GLP-1 Medications: 32% deniedSpecialty Medications: 25% deniedMental Health: 20% denied

Full Anthem denial report →

Your rights as a Connecticut insurance patient

In Connecticut, patients are protected by specific rights when it comes to health insurance claims. They have the right to an internal appeal, allowing them to contest a denial directly with their insurer. If the internal appeal does not resolve the issue, patients can request an external Independent Medical Review, providing an unbiased evaluation of their case. The Connecticut Insurance Department oversees these processes, ensuring compliance and fairness. Additionally, filing a complaint with the department is free and can create pressure on insurers to reconsider their decisions, further empowering patients in their pursuit of rightful coverage.

Connecticut Insurance Department
https://portal.ct.gov/cid

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How to appeal a denial in Connecticut

1
Request the denial in writing
Ask your insurer for the specific clinical criteria and coverage policy they used to deny you. They are legally required to provide it within 30 days.
2
File your internal appeal
Send a written appeal to your insurer within 180 days. Cite your doctor's clinical documentation, relevant medical guidelines, and Connecticut insurance law. A well-written appeal citing specific laws wins over 80% of the time.
3
Escalate to the state if denied again
If your internal appeal is denied, file an Independent Medical Review (IMR) with the Connecticut Insurance Department. This is free and decided by independent clinicians. Their decision is often binding.
4
Use disputes.health to generate your letter
Our agents generate a clinic-grade appeal letter in under 15 minutes — citing your state's laws, relevant medical guidelines, and your specific situation. We then submit it to your insurer for you.

How to appeal a denial →GLP-1 denial guide →Mental health denial guide →All public resources →

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The worst health insurers in Connecticutby claim denial rate