Committee advances Kathleen Ungerholt for state health care advocate; nominee emphasizes outreach, analytics and appeals work

Kathleen Ungerholt, nominated to be Connecticut’s health care advocate, told the Executive Legislative Nominations Committee on Jan. 23 that the office is “a capstone opportunity” and described work to expand outreach and modernize systems that handle appeals and consumer assistance.

Ungerholt, who has served as acting health care advocate for about three months, reviewed her career in hospital finance and administration, insurance benefits, government health work and legal advocacy. “In my brief tenure as acting health care advocate, the office has already begun to increase outreach and accessibility opportunities, improve our educational offerings and our consumer communication, modernize work processes to serve more individuals, and build on stronger relationships with providers, carriers, and state and federal colleagues,” she said.

Ungerholt described the office’s caseload and priorities. She said the Office of the Health Care Advocate (OHA) serves about 5,000 consumers a year; about 16 staff focus on individual consumer assistance, supported by one data/reporting position and agency management. Ungerholt said the office’s nurses and case teams review medical records and that when the office pursues appeals “we win health care insurance appeals 70 to 80 percent of the time,” which she said saves money for consumers and the insurance fund that finances the agency.

She told the committee the office needs better data analytics, a modern case-management system, expanded marketing and outreach, and improved accessibility for people with hearing or vision impairments. “We need to be more proactive and not just reactive,” Ungerholt said, adding that the office has been asked to present its consumer-assistance work at a national level.

Committee members pressed Ungerholt about common case types and timing. Ungerholt gave examples in which appeals led insurers to reverse denials: a claim reprocessed from out-of-network to in‑network after review, ambulance bills reprocessed to relieve member liability, and a denied cancer‑surgery claim reprocessed with no member liability. She said many denials are overturned after the office obtains medical records and a clinician review: “less than 1% of people who are denied either prior authorization or claims ever even appeal the denial,” she said, and of those who do appeal “they’re typically overturned about 70 to 80% of the time.”

Legislators raised broader issues such as prior authorization, step therapy, peer‑review specialty matching, and coding. Ungerholt said the office supports shifting more specificity and, in some cases, the burden of proof to insurers and noted New Jersey as an example for prior authorization rules. She also described conversations with carriers and with the Department of Insurance to obtain information and help consumers when market disruptions occur.

Members asked about OHA resources and outreach. Ungerholt said the agency has about 18 total staff, that one attorney recently left for another state role, and that the office has roughly $50,000 budgeted for advertising and outreach; she said she planned listening tours and in-person community engagement. Ungerholt said the office handles contacts by triage, typically responding the same day if contacted by 3 p.m., and that staff work in teams to move urgent matters to the front of the line.

The committee moved to consider Ungerholt’s nomination in its business session. A motion to advance the nomination was made by Senator Looney and seconded by Representative Godfrey; the nomination was approved by roll call and will move forward for further consideration.