Seattle's KING 5 TV recently did a story on the case of a Tacoma man diagnosed with stage 4 cancer. After trying other treatments, his apparent only remaining option is an experimental anti-cancer drug that his insurer refuses to cover.
He contacted our office, and we're helping him navigate the appeals process. Many people don't realize that a denial by your health insurer is not the final word on the matter. There are multiple rounds of appeals available, including to what's called an "independent review organization," which is a group that has the power to require your insurer to cover a treatment or procedure. And more than a quarter of the people who appeal to an independent review organization win.
How to appeal the decision? We've put together a detailed appeals guide with sample letters to send your insurer. Take a look -- and don't give up.
Here's the story from KING 5:
Monday, March 26, 2012
Friday, March 23, 2012
Hearing next week on Humana's request to acquire Arcadian Health Plan
From our public notices web page:
The Insurance Commissioner has scheduled a hearing for March 27, 2012 at 10:00 a.m. Pacific Time in his Tumwater, Washington office to consider whether he should approve or deny Humana Inc.’s request to acquire Washington-based Arcadian Health Plan, Inc.
Arcadian Health Plan, Inc. offers Medicare Advantage health products through the federal Centers for Medicare and Medicaid Services, and is wholly owned by its parent company, Arcadian Management Services, Inc. Arcadian Management Services, Inc. is currently owned by five venture capital investment funds affiliated with Morgan Stanley Dean Witter, and by Arcadian employees. Humana Inc. proposes to purchase the parent company and all of its subsidiaries including Arcadian Health Plan, Inc.
Humana Inc., which had $36.8 billion in revenue in 2011, and has 11.2 million covered individuals in its medical plans and another 7.3 million in its specialty plans nationwide, is proposing to acquire all outstanding stock of Arcadian Management Services, Inc.. If approved, Humana Inc. would wholly own Arcadian Management Services, Inc. and all six of its subsidiary health carriers including Arcadian Health Plan, Inc.; Arkansas Community Care, Inc.; Arcadian Health Plan of North Carolina, Inc.; Arcadian Health Plan of Georgia, Inc.; Arcadian Health Plan of Louisiana, Inc.; and Arcadian Health Plan of New York, Inc.
The public is notified that all interested parties may submit letters of support or objections and/or may participate in the hearing by appearing in person or by telephone. To view the Notice of Hearing, which includes advice on how to participate and other related documents, go to http://www.insurance.wa.gov/orders/hearings_proceedings.shtml
The Insurance Commissioner has scheduled a hearing for March 27, 2012 at 10:00 a.m. Pacific Time in his Tumwater, Washington office to consider whether he should approve or deny Humana Inc.’s request to acquire Washington-based Arcadian Health Plan, Inc.
Arcadian Health Plan, Inc. offers Medicare Advantage health products through the federal Centers for Medicare and Medicaid Services, and is wholly owned by its parent company, Arcadian Management Services, Inc. Arcadian Management Services, Inc. is currently owned by five venture capital investment funds affiliated with Morgan Stanley Dean Witter, and by Arcadian employees. Humana Inc. proposes to purchase the parent company and all of its subsidiaries including Arcadian Health Plan, Inc.
Humana Inc., which had $36.8 billion in revenue in 2011, and has 11.2 million covered individuals in its medical plans and another 7.3 million in its specialty plans nationwide, is proposing to acquire all outstanding stock of Arcadian Management Services, Inc.. If approved, Humana Inc. would wholly own Arcadian Management Services, Inc. and all six of its subsidiary health carriers including Arcadian Health Plan, Inc.; Arkansas Community Care, Inc.; Arcadian Health Plan of North Carolina, Inc.; Arcadian Health Plan of Georgia, Inc.; Arcadian Health Plan of Louisiana, Inc.; and Arcadian Health Plan of New York, Inc.
The public is notified that all interested parties may submit letters of support or objections and/or may participate in the hearing by appearing in person or by telephone. To view the Notice of Hearing, which includes advice on how to participate and other related documents, go to http://www.insurance.wa.gov/orders/hearings_proceedings.shtml
Thursday, March 22, 2012
Our complaint- and rates Web applications will be down over the weekend
Two of our most popular Web applications will be off-line this weekend because of scheduled maintenance to our imaging software.
From 5 p.m. Friday until 8 a.m. Monday, these two systems will be down:
From 5 p.m. Friday until 8 a.m. Monday, these two systems will be down:
- Online complaint filing (where consumers can file complaints against their insurance company)
- Our health insurance rate request lookup (where you can see which insurers have filed proposals to increase health insurance premiums)
Wednesday, March 21, 2012
Health care reform: Two years later, what's changed?
From a press release we put out this morning:
The Affordable Care Act’s most controversial component – the mandate requiring everyone to have health insurance – is still two years away. But two years after the law’s enactment, many Washington consumers are quietly benefitting from many of the laws lesser-noticed provisions.
“The Affordable Care Act’s individual mandate gets most of the attention, but it shouldn’t overshadow the success stories of the early reforms,” said Insurance Commissioner Mike Kreidler. “By far the most popular benefit of health reform that we hear about is the ability for parents to keep their adult kids on their health plans – especially in today’s economy – and there are many more.”
Among the changes that have already taken effect here in Washington state:
■More than 2.4 million Washingtonians no longer face lifetime limits on their health benefits.
■More than 52,000 young adults up to age 26 have been able to stay on their parents’ health plans.
■More than 1.2 million Washingtonians now have coverage for preventive care with no co-pays or deductibles.
For much more information about what's changed and is changing, click on the link above.
The Affordable Care Act’s most controversial component – the mandate requiring everyone to have health insurance – is still two years away. But two years after the law’s enactment, many Washington consumers are quietly benefitting from many of the laws lesser-noticed provisions.
“The Affordable Care Act’s individual mandate gets most of the attention, but it shouldn’t overshadow the success stories of the early reforms,” said Insurance Commissioner Mike Kreidler. “By far the most popular benefit of health reform that we hear about is the ability for parents to keep their adult kids on their health plans – especially in today’s economy – and there are many more.”
Among the changes that have already taken effect here in Washington state:
■More than 2.4 million Washingtonians no longer face lifetime limits on their health benefits.
■More than 52,000 young adults up to age 26 have been able to stay on their parents’ health plans.
■More than 1.2 million Washingtonians now have coverage for preventive care with no co-pays or deductibles.
For much more information about what's changed and is changing, click on the link above.
Thursday, March 15, 2012
Where -- and why -- to find flood coverage
Another post for National Flood Safety Awareness Week: Here in the rainy Northwest, we can't say this often enough: a standard homeowners insurance policy does NOT cover flooding.
The good news is that flood insurance is widely available through the National Flood Insurance Program. It's a federally run insurance program, but sold by local agents and brokers. For most homeowners, the NFIP is the first stop for flood coverage.
If you live in an area with a high chance of flooding (a "Special Flood Hazard Area"), your lender will generally require you to have flood insurance. Even if you live in a minimal or moderate flood hazard area, you may still want to buy it.
There are, however, limits to federal flood insurance. For commercial structures, for example, the NFIP maximum is $500,000 for the building and $500,000 for the contents. Businesses also may need additional coverage that isn't available through the NFIP, such as business interruption coverage.
Wednesday, March 14, 2012
Insurance company claims representative pleads guilty to fraud on her own car
A Puyallup woman has pleaded guilty to attempted forgery and attempted insurance fraud after submitting a bogus receipt for a $1,609 windshield repair to her insurance company.
Candice Leigh Chapman, 31, was sentenced last week to 45 hours of community service and a deferred sentence.
In June of 2010, Chapman filed a claim saying that she'd had a damaged windshield replaced in her Volkswagen Touareg and had paid for the repair herself. She emailed a copy of a quote from a Seattle auto glass company, with "paid" stamped on the bottom.
But when her insurer, Farmers, called the glass shop to confirm the bill, the shop said it had never repaired or replaced the windshield. Nor do they use a "paid" stamp. At that point, Farmers turned the investigation over to the state insurance commissioner's Special Investigations Unit.
The unusual wrinkle in this case is what Chapman did for a living: She was an insurance company claims representative at a different insurance company. And her primary job responsibility was handling auto glass claims.
Candice Leigh Chapman, 31, was sentenced last week to 45 hours of community service and a deferred sentence.
In June of 2010, Chapman filed a claim saying that she'd had a damaged windshield replaced in her Volkswagen Touareg and had paid for the repair herself. She emailed a copy of a quote from a Seattle auto glass company, with "paid" stamped on the bottom.
But when her insurer, Farmers, called the glass shop to confirm the bill, the shop said it had never repaired or replaced the windshield. Nor do they use a "paid" stamp. At that point, Farmers turned the investigation over to the state insurance commissioner's Special Investigations Unit.
The unusual wrinkle in this case is what Chapman did for a living: She was an insurance company claims representative at a different insurance company. And her primary job responsibility was handling auto glass claims.
Flood awareness week: How to spot a flood-damaged car
In honor of National Flood Safety Awareness Week, here are some pointers on spotting a flood-damaged car:
-Smell. Particularly here in the rainy Pacific Northwest, it's very hard to dry out a flooded car quickly enough to prevent mold and mildew in the carpets, padding below the carpets, and the upholstery.
-Moisture in odd places inside the car. For example, look for moisture or condensation behind the gauges on the dashboard, a clock, and the display panel of a stereo. (Note: It's fairly common in the Northwest to see water or condensation in exterior lights, like taillights, turn signal lights, etc. in older vehicles. That's not necessarily a sign of flooding. Rain may have just seeped in through the gaskets that are supposed to seal the lights.)
-Check the car's unique Vehicle Identification Number to see if it has been reported as a salvage vehicle. These numbers are typically found on a small metal plate visible through the front windshield at the front of the dashboard. The National Insurance Crime Bureau runs a website where you can check VIN numbers -- up to 5 a day -- for free. (Hint: it's case-sensitive.)
-Dampness, mold, silt, mud or rust in low spots on the vehicle, such as under the spare tire in the trunk, the interior crevices of the trunk behind the wheels or in the glove compartment.
-Interior rust, such as springs under the seats.
-Check the car's oil. Engine oil contaminated with water will often look like chocolate milk.
-Smell. Particularly here in the rainy Pacific Northwest, it's very hard to dry out a flooded car quickly enough to prevent mold and mildew in the carpets, padding below the carpets, and the upholstery.
-Moisture in odd places inside the car. For example, look for moisture or condensation behind the gauges on the dashboard, a clock, and the display panel of a stereo. (Note: It's fairly common in the Northwest to see water or condensation in exterior lights, like taillights, turn signal lights, etc. in older vehicles. That's not necessarily a sign of flooding. Rain may have just seeped in through the gaskets that are supposed to seal the lights.)
-Check the car's unique Vehicle Identification Number to see if it has been reported as a salvage vehicle. These numbers are typically found on a small metal plate visible through the front windshield at the front of the dashboard. The National Insurance Crime Bureau runs a website where you can check VIN numbers -- up to 5 a day -- for free. (Hint: it's case-sensitive.)
-Dampness, mold, silt, mud or rust in low spots on the vehicle, such as under the spare tire in the trunk, the interior crevices of the trunk behind the wheels or in the glove compartment.
-Interior rust, such as springs under the seats.
-Check the car's oil. Engine oil contaminated with water will often look like chocolate milk.
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