headshot of Senator Crisco (lo-res)

News From

State Senator

Joseph J. Crisco, Jr.

Chief Deputy President Pro Tempore
& Federal Relations Liaison

Representing Ansonia, Beacon Falls, Bethany, Derby, Hamden, Naugatuck & Woodbridge

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Contact: Lawrence Cook

March 19, 2010

Insurance Committee Approves Bill That Increases Transparency Behind Denied Medical Claims

Senators Looney and Crisco say key initiatives to protect patients are one step closer to becoming law

Hartford: State Senator Joseph Crisco (D-Woodbridge) says the General Assembly’s Insurance and Real Estate Committee has approved a bill this week which would create greater fairness for patients who are denied coverage from their health insurance provider.

The Committee also approved a bill on March 16th that expands coverage of routine patient care costs for clinical trial patients to clinical trials for Multiple Sclerosis and Parkinson’s disease, and ensures that third party payers retain their responsibility to patients.

Each of these bills reflects the changing needs of patients to navigate through increasingly complex healthcare coverage and medical services, and each underscores our commitment on this committee to address those needs,” Senator Crisco said.

Currently, when a managed care organization (MCO), health insurer, or utilization review company denies coverage they are not required to give the patients all records explaining the decision. Senate Bill 258, AN ACT CONCERNING APPEALS OF HEALTH INSURANCE BENEFITS DENIALS, would change that and require the MCO or health insurer to give the patient all appropriate medical records upon request.

Senate Majority Leader Martin Looney testified in favor of the proposal and will advocate for its final passage on the floor of the Senate. “The proposal requires the insurer to provide all relevant information to the patient as to why the claim was denied—something that most people think is already required by law,” said Senator Looney. “This is a common sense solution to a problem that patients face everyday and will help to relieve the burden on those who legitimate treatment needs are being challenged by an insurance company.”

The Insurance Committee also approved SB 260, AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR ROUTINE PATIENT CARE COSTS FOR CLINICAL TRIAL PATIENT. The bill would expand coverage of routine patient care costs for clinical trial patients to clinical trials for Multiple Sclerosis and Parkinson’s disease and ensure that third party payers retain their responsibility to patients.

In 2001 the Connecticut General Assembly passed PA 01-171 which required insurers to sustain their responsibility to patients who participate in clinical trials for cancer. At that time Senator Looney expressed his belief that this coverage requirement should not be limited to cancer but rather should apply to clinical trials for all serious or life-threatening conditions. Senator Looney will continue to advocate for the expansion of coverage to include all serious and life- threatening diseases.

“These courageous patients are willing to take a risk by participating in a clinical trial that is attempting to find more effective treatment for a specific disease,” said Senator Looney in his testimony to the Insurance and Real Estate Committee. “These patients are, in a profound sense, heroes and heroines. They are taking a risk to help others who share their particular condition. These patients deserve our encouragement and support. They do not deserve to be billed for procedures that their insurers would cover if they were not in a clinical trial.”

The proposal requires that insurance companies cover standard of care treatment for patients who are enrolled in clinical trials for Multiple Sclerosis and Parkinson’s disease as they would for patients who are not enrolled in clinical trials. The language in the bill states that routine patient care is care "that would otherwise be covered if such services were not rendered pursuant to a clinical trial." Insurers vary significantly in how they cover these costs. This legislation would create a more rational outcome for patients.


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Lawrence Cook

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Hartford, CT 06106-1591

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