Eliott Dear: Connecticut Joins New York in Bypassing Federal IDR

The state-IDR list keeps growing. New York set the template with Article 6 §603-d. Texas followed with its Department of Insurance arbitration program. New Jersey, Georgia, and New Mexico each built their own version. Connecticut now operates a fully independent OON dispute pathway through the Connecticut Insurance Department.

For physicians practicing in Connecticut with fully-insured commercial OON claims, federal IDR is no longer the only option — and federal IDR is not the better option. Eliott Dear breaks down the choice.

The Connecticut Pathway

Connecticut law requires fully-insured commercial carriers to participate in a state-level dispute resolution process for OON emergency and certain non-emergency claims. The Connecticut Insurance Department administers the process. The reasonableness factors look familiar to anyone who has filed in New York: charges, FAIR Health UCR data, complexity of the procedure, the provider’s level of training and experience, and the carrier’s usual rates for in-network providers of comparable training.

The crucial structural feature is the same as New York’s: the state regulator administers the process and enforces the award. The CT Insurance Department has the same insurer-license authority that NY DFS has. The collection rate on state-IDR awards in Connecticut, like New York, approaches 100%.

Why Federal IDR Is Worse for CT Physicians

Federal IDR median resolution time is 200+ days. CT IDR resolves typically within 30-60 days depending on case complexity. Federal IDR awards have no private right of action under the Fifth Circuit’s 2025 ruling; CT awards are enforced by the state insurance regulator. Federal IDR anchors awards in QPA computations the carriers themselves audit; CT IDR anchors awards in FAIR Health UCR data drawn from a nonprofit independent source.

The asymmetry is structural. State IDR wins on timeline. State IDR wins on enforcement. State IDR wins on data source neutrality. The only reason to file federal IDR for a CT-eligible claim is statutory exclusion — a self-funded ERISA plan that escapes state regulation.

Eligibility Mechanics in Connecticut

The CT IDR pathway covers fully-insured commercial OON claims for emergency services and certain non-emergency services performed at in-network facilities by OON providers. ERISA self-funded plans are federally preempted. Medicaid (HUSKY Health and Medicaid Managed Care) is excluded by statute. Medicare Advantage is excluded.

The initial diagnostic question on any Connecticut claim is therefore the same as on a New York claim: read the EOB carefully, identify the plan type behind the carrier envelope, and route to the right track. State IDR for fully-insured commercial. Federal IDR for self-funded ERISA. Appeal track for Medicaid Managed Care and Medicare Advantage.

How Claims Assassins Files in Connecticut

Eliott Dear files state IDR in Connecticut through the CT Insurance Department’s administrative process. Each filing is attorney-signed. Each filing pulls FAIR Health UCR data for the relevant CT-specific geo-zip. Each filing reconstructs the carrier’s in-state historical-paid pattern for the same CPT codes. The submission discipline mirrors what gets filed in New York, Texas, New Jersey, and the other state-IDR states.

Same playbook. State-specific statutes. State-regulator enforcement. The math works the same way.