CT SB01082

Expands utilization review to include retrospective assessments (in addition to prospective and concurrent), and adds definitions for adverse determinations, medically necessary services, and other key terms effective October 1, 2011.

Requires utilization review companies to provide written notification of determinations within two business days, allow oral authorization with confirmation numbers, and prohibit reversal of approved determinations unless based on inaccurate provider information.

Establishes expedited appeals process for emergency situations to be completed within one business day, and requires final adjudications to be reviewed by a specialist physician at the company's expense with Connecticut-licensed physician authority for Connecticut enrollees.

Mandates utilization review companies provide pre-appeal hearings upon request with enrollee, provider, and specialist physician participation, and record such hearings for commissioner appeals.

Requires companies to file annual reports with the Insurance Commissioner detailing managed care clients, denied determinations, appeal outcomes, and mental health service denials separately categorized.