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Bill

SB 1044

AN ACT CONCERNING ADVERSE DETERMINATION AND UTILIZATION REVIEWS.

2025 Regular Session Introduced by Martin Looney

SB 1044 modifies Connecticut insurance regulations governing how insurers deny coverage and assess medical necessity, affecting patient access to care and insurer procedures.

REF. TO JOINT COMM. ON Public Health
#adverseevents(medical) #healthinsurance #utilizationreview
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Bill Summary · SB 1044

Legislative bill overview

SB 1044 addresses the processes by which health insurance companies make "adverse determinations" (denials of coverage) and conduct utilization reviews (assessments of medical necessity). The bill modifies Connecticut's existing regulations governing how insurers evaluate and communicate coverage decisions to patients and providers.

Why is this important

Insurance denials significantly impact patient access to care and can delay or prevent necessary medical treatment. Clear procedures and timelines for adverse determinations affect both individual patients navigating coverage disputes and healthcare providers managing treatment authorization. These regulatory standards influence healthcare costs, quality of care, and the balance of power between insurers and patients.

Potential points of contention

  • Insurer burden vs. patient protection: Stricter review procedures and faster decision timelines may increase operational costs for insurers, potentially raising premiums, while patient advocates argue faster decisions protect urgent medical needs
  • Definition of "medical necessity": Disputes over what criteria insurers should use to deny coverage—evidence-based standards vary and leave room for subjective interpretation
  • Appeal rights and remedies: Questions about whether the bill provides sufficient independent review mechanisms and what financial remedies apply when insurers wrongfully deny claims

Compiled from official sources — confirm details with the bill’s official record.

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