Every day, the Office of the Healthcare Advocate fights for Connecticut residents who face health insurance obstacles. These are real stories from people just like you—your neighbors who needed someone in their corner when insurance companies denied coverage, refused to pay claims, or created barriers to essential care.
Below are just a few examples of how we've made a difference. Each story represents our commitment to ensuring every Connecticut resident receives the healthcare they deserve, regardless of insurance complications or coverage denials.
Names have been changed to protect confidentiality.
Mr. Baker’s* insurance company denied approval for necessary covered surgery. OHA determined the hospital had mistakenly requested authorization for an inpatient procedure when outpatient surgery was appropriate. Intervening with the insurance company, OHA confirmed authorization for the outpatient procedure, saving Mr. Baker over $25,000.
Our consumer was receiving mental health treatment, but his carrier denied additional treatment despite it being clear he needed further medical help. OHA intervened by filing an external appeal. It was successful, and the denial was overturned. An additional 52 days of treatment were covered at the residential level of care. Without further assistance, he would have been at risk of harm to himself and possibly others. Savings: $3,700 X 52 days: $192,400.
Mrs. McDermott had an MRI after an arm injury. With no improvement in her pain after several weeks, her doctor ordered a second MRI. Insurance denied the second MRI, stating she must first undergo six weeks of physical therapy. OHA intervened, resulting in immediate preauthorization for a second MRI (which revealed a need for further treatment), saving Mrs. McDermott approximately $3,000.
A patient's mother contacted OHA because the insurance carrier denied residential psychiatric mental health services for her child. She strongly felt her child needed intensive care and asked OHA what she could do. An expert case manager was assigned, and OHA filed the appeal, which resulted in a determination that the denial of services was overturned. As a result, 23 days of residential stay was paid by the insurance carrier. Savings for the consumer $85,100.
Ms. Miller emailed OHA, at Healthcare.Advocate@ct.gov, for help after 18 frustrating months of her own unsuccessful attempts to obtain coverage for specialized glasses she needed to see after recovering from a stroke. Her OHA Team obtained a one-time exception from the insurance company for otherwise non-covered LV telescopic glasses, saving Ms. Miller $3,600.