The medical plight of a friend of mine has spurred my colleagues and me into proposing legislation concerning insurance coverage for medically necessary treatments.
Daniel Pearson, the state director for Educators for Excellence and who lives in the Danbury area, had an AV heart block and needed an implantable cardioverter defibrillator. His condition, he said, is likely due to open-heart surgery he had about a decade ago.
Four doctors said he needed the surgery ASAP, as it was only a matter of when, not if, he'd go into cardiac arrest, have a stroke or a heart attack.
His insurance carrier's subcontractor, however, denied his doctor's surgery request, the appeal and the peer-to-peer review.
The surgery was estimated to cost $139,000, and Daniel needed to raise 50% prior to the procedure.
First, the good news. Daniel raised $75,000 in a GoFundMe campaign and had successful surgery last week.
Not everyone, however, has the good fortune to have a network of people to raise awareness and money on their behalf at a time when life-saving care is needed.
My colleague, Rep. Raghib Allie-Brennan, introduced a bill (House Bill 6147) aiming to enhance the fairness, transparency, and timeliness of insurance coverage decisions and appeals, ensuring that patients have access to medically necessary treatments without undue delays or denials.
The proposed legislation includes the following key measures:
- Requiring insurance companies to align their coverage guidelines with up-to-date, evidence-based medical standards. It mandates that treatments recommended by licensed specialists, particularly life-saving treatments, be covered unless there is clear medical evidence to deny them.
- Streamlining the appeals process, requiring non-urgent appeals to be decided within 10 business days and urgent appeals to be resolved within 48 hours. It also establishes an independent medical review board to ensure appeals are decided based on current medical evidence, with decisions binding in urgent cases.
Unfortunately, we or someone we know has experienced barriers our healthcare system creates for people like Daniel.
No one should have to beg for life-saving care. I join Rep. Brennan in supporting House Bill 6147. |
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| Danbury Proton Gets the OK |
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But there is also good news on the medical front, and it's right here in Danbury!
The Office of Health Strategy has reached an agreement with Danbury Proton, LLC, allowing the establishment of a $72 million proton therapy center in Danbury. This is an issue that I, alongside Mayor Roberto Alves, advocated for directly to the commissioner.
This center -- which will offer proton beam therapy, a cutting-edge cancer treatment not yet available in Connecticut -- will feature one treatment room initially to ensure it aligns with scientific research.
The center is expected to meet state conditions, including licensing, registration, and accreditation, and must become a Medicaid provider. It will also allocate at least 5% of net revenue to support uninsured patients or reduce out-of-pocket costs. Additionally, the agreement ensures that any contract increases with commercial insurers do not exceed the state's cost growth benchmark.
The facility is being developed in collaboration with Hartford HealthCare and Yale New Haven Health Systems and is expected to open by late 2026.
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| There's a Danbury App for That |
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| Mayor Roberto L. Alves has introduced the myDanbury app to make it easier to connect with City Hall!
The app makes it easier than ever to engage with our community, whether you need to report an issue or access city services.
With the myDanbury app, you can report problems such as blight or potholes, securely pay taxes, ask the mayor questions during live "Ask the Mayor" sessions, request permits, receive voting information, and much more.
Download the app today from the Apple App Store or Google Play Store. |
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| Cold Weather Protocol Extended |
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| Governor Ned Lamont announced that due to an updated weather forecast showing that the current stretch of brutally frigid conditions Connecticut is experiencing will continue for at least another day longer than anticipated, he is extending the duration of the state’s severe cold weather protocol to remain in effect until noon on Saturday, January 25.
The protocol had originally been set to expire on the afternoon of Friday, January 24.
While activated, the protocol initiates a series of actions to ensure that the most vulnerable populations receive protection from the severe cold.
Shelters and warming centers are open throughout Connecticut. Anyone in need of a place to stay warm can be directed to nearby locations by calling 2-1-1 or viewing the list of available options that has been published online at 211ct.org.
Transportation can be provided to a shelter or warming center if needed. |
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| Portable Heater Reminders |
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| The cold snap in Connecticut may lead some to use portable heaters in their homes to help stave off Jack Frost.
Using these heaters come with some risks, however, as they are the leading cause of home fires in January and February.
Here are some precautions you should take, according to FEMA, if you use portable heaters:
- Turn portable heaters off when you go to bed or leave the room.
- Keep anything that can burn – i.e. bedding, clothing, mattresses, furniture, paper products -- at least three feet away from portable heaters.
- Plug in portable heaters directly into outlets; do NOT plug them into extension cords or power strips.
- Inspect and replace damaged cords, broken outlets or loose connections.
- Use portable heaters with automatic shutoffs so, if they tip over, they turn off.
- Only use portable heaters approved by a recognized testing lab.
It's extremely important to stay warm, but it's also important to stay fire safe this winter.
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| Two goals, two games!
Congratulations to Connecticut native Patrick Agyemang, who scored in each of his first two games (caps) for the U.S. Men's National Team.
Agyemang, a 24-year-old forward who was born in East Hartford and attended East Hartford High School, scored on his national team debut in a 3-1 victory against Venezuela on Jan. 18.
He followed that up with a 90th-minute goal against Costa Rica in a 3-0 victory on Jan. 22.
Agyemang was an all-conference soccer player in high school and played club soccer for the Hartford Hellions.
After high school, he played soccer at Eastern Connecticut State University, scoring 30 goals in 39 matches, before transferring to the University of Rhode Island.
Agyemang currently plays professionally for Charlotte FC, which took him 12th in the first round of the 2022 MLS draft.
Way to go Patrick! |
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