Ron Napoli, Jr

The Office of the Healthcare Advocate assists consumers with healthcare issues. OHA's primary focus is communicating with people on their consumer rights.

Here are some informational facts on common healthcare issues and a snapshot of the services offered by OHA:

Men's Health Crisis - Knowledge and Empowerment

Men are less likely to seek help when it comes to their health. Sometimes referred to as the 'silent health crisis,' OHA wants men to be aware of their health needs.

Heart Disease: Men are 1½ times more likely than women to die from heart disease. Before age 65, 3 times more men than women die from heart attacks.

Suicide: Men are 4 to 10 times more likely than women to die by suicide. Men ages 45 to 59 have the highest suicide rate in the U.S. Suicide rates in this age group has increased significantly in the past 5 years and have doubled since 1999.

Cancer: Men are 1½ times more likely than women to die from cancer. Men have a higher probability of developing cancer and don’t survive as long once diagnosed. Lung cancer, the leading cause of cancer death for males, kills 2½ times more men than women. Melanoma, the cancer with the greatest increase in incidence since 1973, kills nearly 2 times as many men as women.

Lunch & Learn - November 23rd

The next OHA Lunch & Learn program is November 23. Lunch & Learn sessions are 30 minutes long – 15 minutes of presentations and 15 minutes for your questions. The program is conducted via Zoom and reservations are NOT required. Just click here for the ZOOM link and log in to participate.

Lunch & Learn is a helpful resource for consumers and medical providers.

Legislative Update: Diabetes Testing, Treatment & Equipment

This year the Legislature updated Connecticut's law covering diabetes testing and treatment. The new law requires health insurers to cover lab and diagnostic tests for all types of diabetes and coverage for medically necessary equipment such as drugs and supplies prescribed by a healthcare provider.

Now, insurers are prohibited from imposing coinsurance, copayments, deductible, and other out-of-pocket expenses that exceed:

• $25 for a 30 day supply of medically necessary insulin prescribed by the insured's doctor
• $25 for a 30 day supply of a medically necessary non-insulin drug prescribed by the insured's doctor
• $100 for a 30 day supply of all medically necessary diabetes devices and diabetic ketoacidosis devices

Colon Cancer: Did You Know?

In May 2021, the U.S. Preventive Services Task Force (USPSTF) updated its Colorectal Cancer Screening Recommendations, lowering from 50 to 45 the age at which individuals should begin screening for colon cancer. The recommended interval between screenings varies depending on the screening methods used and other risk factors, such as patient and family history of prior disease.

Health plans will be required to eliminate cost-sharing (co-pays and deductibles) for colon cancer screening for 45-49 year-olds for any plan year that starts after May 31, 2022. OHA urges health plan members to whom the new recommendations may apply to contact their health plan prior to scheduling a colon cancer screening procedure in order to confirm whether a cost-sharing obligation will be imposed. If you are not satisfied with the answer or don’t understand it, call OHA at 860-418-7001 for free assistance.

OHA ADVOCACY

Insulin Pump Replacement

Citing administrative reasons, a health insurer denied a man coverage for a prescribed insulin pump replacement. After exhausting all appeals of the insurance company's denial, the patient contacted OHA for help. OHA looked at clinical documentation from the patient and the provider and determined the insurer had incorrectly misinterpreted its own policy on the frequency of insulin pump replacements. Thanks to OHA's advocacy, the man saved $1,200 in out-of-pocket expenses.

Medication Denied

A consumer with a respiratory illness contacted OHA after her medication was denied by her insurance carrier. OHA worked with the woman and provided advice on the next steps that led to the medication being approved.

Denial of Coverage

A man with prostate cancer called OHA to appeal his health plan's denial of coverage for the Prostate Decipher test – a genomic test that classifies a cancer. According to clinical studies, classifying the type of prostate cancer is helpful with determining the best treatment. Unfortunately, the Prostate Decipher test is not covered by insurance so only those patients who are willing to pay the $5,000 out-of-pocket cost will benefit.