Eliott Dear: Connecticut Joins New York in Running Its Own IDR

The state-IDR list keeps getting longer. 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, that means a state process run by a state regulator. Eliott Dear breaks down the pathway.

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. The CT Insurance Department is also the regulator that licenses the carrier on the other side of the dispute — the same structure New York has with DFS.

Timeline and Benchmark in Connecticut

CT IDR resolves typically within 30-60 days depending on case complexity. The benchmark in the record is FAIR Health UCR data drawn from a nonprofit independent source.

That is the practical shape of the Connecticut pathway: a timeline measured in weeks, a state regulator running the process, and an independent benchmark in the record.

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. 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. 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 payment history 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. A state regulator administering each process.