Connecticut laws/regulations;

OLR Research Report

March 31, 2011




By: John Kasprak, Senior Attorney

Healthcare Advocate (CGS 38a-1040 to 1050)

The Healthcare Advocate directs the Office of the Healthcare Advocate (OHA). The advocate assists health insurance consumers (1) with managed care plan selection by providing information and assistance, (2) in understanding their rights and responsibilities under managed care plans, and (3) with filing complaints and appeals. He also provides information to the public, agencies, and legislators on problems and concerns of consumers and reviews consumers' health insurance records and pursues administrative remedies on their behalf and with their written consent.


1. The OHA assists consumers file complaints and appeals, including appeals with a managed care plan's internal appeal or grievance process, and informing them about the external appeals process established under the general statutes. How many complaints does your office receive annually? Has this number increased, decreased, or remained relatively constant over the past few years?

2. What type of complaints do you receive? Do the complaints fall into specific categories? If so, what are the most frequent types of complaints? Have the types of complaints changed over time?

3. Do such complaints and appeals tend to be resolved in favor of the consumer or the managed care plan?

4. Does your office make legislative and regulatory recommendations based on the complaints you receive? If so, please describe some of the recommendations the office has proposed and the results.

5. The OHA, by law, may assist consumers with managed care selection. Please describe your office's activities in this area. Do you make specific recommendations as to plan choices for consumers?

6. Another task of the OHA is to educate the general population on their managed care rights and responsibilities. What activities does your office take to accomplish this? Do you find that the state's health care consumers are currently more knowledgeable about the workings of the health care system than they were when you first took the job of advocate?

7. Do you work with other state entities in meeting the obligations of your office?

8. The General Assembly is considering a number of health care reform proposals during the session? What would be your priorities in the crafting of comprehensive health care reform for Connecticut?