2019 Connecticut General Statutes
Title 38a - Insurance
Chapter 700c - Health Insurance
Section 38a-591n - Documents, communications, information and evidence provided to covered person or covered person's authorized representative upon request.
(a)(1) Upon request pursuant to subparagraph (E) of subdivision (1) of subsection (e) of section 38a-591d, the health carrier shall provide free of charge to a covered person or a covered person's authorized representative, as applicable, copies of all documents, communications, information and evidence, including citations to any medical journals, regarding the covered person's benefit request that is the subject of the adverse determination that were not submitted by the covered person or the covered person's authorized representative and were available to the health carrier or the utilization review entity that made the adverse determination at the time such adverse determination was made.
(2) The health carrier shall provide such copies by facsimile, electronic means or any other expeditious method available not later than five business days after the health carrier receives such request in the case of an adverse determination of a nonurgent care request or one calendar day after the health carrier receives such request in the case of an adverse determination of an urgent care request.
(b) (1) Upon request pursuant to subparagraph (F)(iii) of subdivision (1) of subsection (e) of section 38a-591e, subparagraph (E) of subdivision (1) of subsection (d) of section 38a-591f or subparagraph (E) of subdivision (2) of subsection (c) of section 38a-591g, the health carrier shall provide free of charge to a covered person or a covered person's authorized representative, as applicable, copies of all documents, communications, information and evidence, including citations to any medical journals, if applicable, regarding the adverse determination or the final adverse determination, as applicable, that were not submitted by the covered person or the covered person's authorized representative and were not previously provided by the health carrier to the covered person or the covered person's authorized representative.
(2) The health carrier shall provide such copies by facsimile, electronic means or any other expeditious method available not later than:
(A) Five business days after the health carrier receives such request (i) in the case of a final adverse determination of a prospective, concurrent or retrospective review request under section 38a-591e, (ii) in the case of a final adverse determination of a review request under section 38a-591f, or (iii) pursuant to section 38a-591g, except if the covered person or the covered person's authorized representative notifies the health carrier at the time of such request that any of the provisions set forth in subparagraph (B)(i) or subparagraph (C) of subdivision (2) of subsection (c) of section 38a-591g applies, the health carrier shall provide such copies by facsimile, electronic means or any other expeditious method available not later than one calendar day after the health carrier receives such request; or
(B) One calendar day after the health carrier receives such request in the case of a final adverse determination of an expedited review request under section 38a-591e.
(P.A. 12-102, S. 5.)
