(a)(1) Upon request pursuant to subparagraph (E) of subdivision (1) of subsection (e) of § 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.

Terms Used In Connecticut General Statutes 38a-591n

  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Person: means an individual, a corporation, a partnership, a limited liability company, an association, a joint stock company, a business trust, an unincorporated organization or other legal entity. See Connecticut General Statutes 38a-1

(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 § 38a-591e, subparagraph (E) of subdivision (1) of subsection (d) of § 38a-591f or subparagraph (E) of subdivision (2) of subsection (c) of § 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 § 38a-591e, (ii) in the case of a final adverse determination of a review request under § 38a-591f, or (iii) pursuant to § 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 § 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 § 38a-591e.