Data from the Pennsylvania Insurance Department notes that in 2024, individual market qualified health plans denied more than three million claims in Pennsylvania. These denials may have been issued for a variety of reasons, including administrative reasons, concerns regarding medical necessity, or even as cost control measures through prior authorization. However, adverse benefit determinations in health care have serious, sometimes life-threatening, consequences. Covered people being seriously injured or dying because they were denied coverage for medically necessary care is unacceptable, and insurers must be held accountable for harm that occurs due to these benefit determinations.
 
As such, we plan to introduce legislation to add a category of aggravated assault that would apply to Chief Executive Officers (CEOs) of insurance companies if a covered person is caused serious bodily injury or dies as the result of an adverse benefit determination for a medically necessary service. Our bill will establish a penalty for CEOs whose companies are responsible for harm or death and will consequently help ensure that covered people receive the care they need.
 
Please join us in this effort to hold insurance companies and their CEOs accountable for serious injuries or deaths caused by adverse benefit determinations.