Gabriel’s Law

The purpose of this writing is to propose a law for the Commonwealth of Pennsylvania and the United States of America that its insured citizens, covered by the healthcare plan that they pay premiums for in good faith will be covered for the care their doctor recommends for them. This law should provide that their physician who evaluates them in the hospital or other clinical setting shall not be overruled by a clinician simply reviewing a document, and that the care a physician determines to be necessary will be provided and paid for by the insurance company. The insurance company will no longer arbitrarily have the right to deny coverage to the insured based on a chart review, without having a clinician examine the patient to make a determination of medical necessity for care of a patient.

This law will provide that the physician who is examining the patient, actually laying their hands on the patient, has the best interest of the patient in mind will be making recommendations for the care of the patient and that any medication, therapeutic, device or intervention that the physician deems medically necessary should be required by law to be covered by the insurance company for the patient. Insurance companies should not have the authority to deny claims to their beneficiaries arbitrarily. Most of the times the people who are doing the initial reviews are not physicians. So, a physician is ordering a medication, for example, and a nurse at the insurance company has the authority to deny the medication to the patient.

Without examining the patient. Just on the basis of a chart review. This is unacceptable.

Even if a physician gets involved, and reviews a chart, the physician at the insurance company is not evaluating the patient. They are reading a document. It is not the same as putting your hands on a patient, and listening to a person. These decisions affect real people. Sometimes they are just about a medication, sometimes it is a major decision, like will the insurance cover the facility where the patient is receiving care? Sadly, this is something that no person should have to struggle with when they are trying to recover from an injury or illness. They should not have to fight the insurance company when they are fighting for their life, or fighting to regain their speech, or muscle movement.

Gabriel Brown had a terrible accident in late September 2024. He was on his honeymoon with his new bride, Lauren, in Jamaica, where he slipped and fell, struck his head and suffered a cerebral hemorrhage. Gabriel went into a coma, had brain surgery. His transfer to the US was delayed due to a hurricane. When he was finally able to be transferred to the US, he spent time at Broward Medical Center in Fort Lauderdale, then UPMC Hamot in Erie, Select Specialty Hospital in Pittsburgh, UPMC Presbyterian, back to Select Specialty Hospital, UPMC Mercy, and he is currently receiving care at LECOM Senior Living Center in Erie, PA. His young wife, Lauren has struggled to keep her household running on her own, keep up on Gabriel’s care, and has been doing something no loved one should ever have to do. She has been battling the insurance company to get Gabriel’s care paid for. The

premiums for his insurance have been paid in good faith. Lauren has made sure that all of Gabriel’s bills were covered when he fell ill. This is something a loved one should not have to worry about. She has enough things to worry over-first if her new husband was going to survive, then if he would talk again, if he would be able to communicate with her, if he would be able to walk again? She should not have to worry again about where the insurance company wants to move him to next because they don’t want to pay for the facility, they just required him to move to.

It is time for medical decision making to be returned to the physicians who are caring for the patients who are paying the premiums. The patients are suffering the consequences, in more ways than one. It is time that the insurance companies’ obscene profits get back to the patients, they should be covered for the services that they are paying for in good faith, and their physicians deem medically necessary. For Gabriel and Lauren, everyone who has walked this terrible journey with them and for every patient who should never have to take this journey.

I am asking Senator Dan Laughlin to take on Gabriel's Law and help push this legislature. Senator Laughlin and his office has been a great resource in helping Gabe get into UPMC Mercy's DOC program to help him wake up out of a coma after United Healthcare denied countless times.

Thank you for your time in consideration of this law.

Sincerely,

Melodie Chludzinski, DO and Lauren Esper

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IF YOU’D LIKE TO DONATE PLEASE DONATE THROUGH OUR GOFUNDME: https://www.gofundme.com/f/support-gabes-recovery-after-tragic-accident?attribution_id=sl:5373ea13-c537-4afe-8219-74fe8a6a992a&utm_campaign=man_sharesheet_dash_ai&utm_content=amp8_t4&utm_medium=customer&utm_source=copy_link&fbclid=IwVERFWAQB5PNleHRuA2FlbQIxMQBzcnRjBmFwcF9pZAo2NjI4NTY4Mzc5AAEeLLiKJAZhEaX3jAHEQbWNVXW98g8HNFiohSIcALlh75Si3KpmidRJVqasiZA_aem_KUlXvOhm6pBz8NssRLsR5Q

YOU CAN ALSO DONATE THROUGH MY PERSONAL VENMO ACCOUNT: Lauren-Esper-1

DONATIONS AFTER SIGNING THE PETITION DO NOT GO TO GABE AND I!

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