OIC’s SHIBA can help consumers find health benefits

During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.
The Office of the Insurance Commissioner oversees Washington’s Statewide Health Insurance Benefits Advisors (SHIBA). SHIBA offers free, unbiased and confidential assistance with Medicare and other health care choices.
SHIBA can help you:

• Understand your health care coverage options and rights.
• Determine your general eligibility for health care coverage programs.
• Evaluate and compare health insurance plans.

In 2013, our 570 SHIBA volunteer advisors helped 54,000 people understand their health insurance. Advisors are available in communities throughout the state;.
For people who are about to turn or recently turned 65, we host Medicare events around the state. You can also find information about Medicare on our website.
Are you interested in becoming a SHIBA volunteer? Find out more.

Important tips for insurance consumers

Editor's note: During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Today, we are sharing tips with Washington insurance consumers based on questions and complaints we’ve received over the years. These tips are general and are intended to help you avoid common insurance pitfalls.

• If you are having a problem with your insurance company or agent that you can’t get resolved, we recommend that you call us about it as soon as you are having the problem. We do get calls from people who wait years (yes, years) before they call us. By that time, it’s very hard to untangle the issues. We will try, but it’s significantly more difficult. Contact us at 1-800-562-6900 or on our website. The sooner you contact us, the sooner we can determine how we might be able to help.
• Do an annual review of your policies and what possessions you are covering. A lot can happen in 12 months—did you remodel your home? Buy a car? Sell a car? Buy a boat? Have a birthday? Any of these things could affect your insurance premium. For homeowner or renter insurance policies, the National Association of Insurance Commissioners (NAIC) has a home inventory checklist available as a PDF or as an app.
• Many people have their auto and home policies with the same insurer. However, many do not. If you change address or have any other issue that might involve both policies, be sure to contact both insurers to discuss your situation and make any needed changes to policies.

It’s important to be an informed consumer, and we are here to help. OIC’s website has a wealth of information about auto, home, health and life insurance for Washington consumers at www.insurance.wa.gov. Our consumer site is tablet- and mobile-friendly.

Consumers have rights to appeal claim denials

Editor's note: During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Sometimes, insurance companies deny claims for reasons that vary as widely as there are claims. Here is some information about insurance claim denials and your appeal rights.

Health insurance

Most health plans are required to comply with a very specific appeal process. However, this requirement doesn’t apply to some health plans, such as Medicare or Apple Health (Medicaid) plans.

Other types of insurance, such as long-term care or disability insurance, are required to provide an appeal process but can create their own process.

If you want to file an appeal with your health plan, contact them and ask: “What do I need to do to file an appeal?” After that, you’ll need to collect materials that support your appeal, such as:

• The health problems that can or will arise if the company doesn’t pay for this treatment, plus an estimate of the cost of treating those problems.
• Any medical journal articles or studies that show the treatment’s effectiveness.
• Letters from your doctors describing why you need this treatment.

After you send your appeal materials to the health plan, be persistent. Most people don’t win at the first level of appeal, but the odds of winning increase as you reach higher levels of appeals. The chance of winning is highest when your health plan appeal reaches the final level, called an “Independent Review Organization.”

For more tips, please visit the appeals section of our website.

Property and casualty insurance

With property and casualty insurance—such as homeowner, renter and auto insurance—consumers generally can use the appraisal provision of their auto or home policy or the arbitration provision for personal injury protection (PIP) and under- or uninsured motorist (UIM) claims on auto policies. Appraisal provisions are used for disputes of claim value, and arbitration provisions are generally used when the application or availability of coverage is being questioned.

More information

• You can file a complaint against your insurance company, regardless of what type of policy you have, with OIC’s consumer advocates.
• For Medicare questions, you can contact a Statewide Health Insurance Benefits Advisor (SHIBA).
• People must apply for Apple Health through Washington Healthplanfinder. Consumers who are enrolled in Apple Health must contact the Health Care Authority with appeals and follow-up issues.

March 2-8 is National Consumer Protection Week

You may have seen that this week is National Consumer Protection Week. The Washington state Insurance Commissioner has an entire unit devoted to helping consumers who experience trouble with their insurance policies or companies. In 2013, we responded to more than 5,000 inquiries from consumers and helped recover $8.4 million in insurance billings, refunds and other claims-related issues.

Our consumer advocates can help:

• Answer questions about home, auto, health, life, annuities, business and other insurance. 
• Understand your insurance rights, including your health insurance appeal rights and the process. 
• Understand how health reform works. 
• Look into complaints against insurance companies. 
• Provide you with information about your shopping options. 
• Verify if an agent, agency, or company is authorized to sell insurance in Washington state.

We also share information of interest to insurance consumers on this blog and through our social media channels. Many of our posts are generated by questions our consumer advocates receive from Washington citizens. Consumers can reach us by phone at 1-800-562-6900 and online via our web form. Read more about consumer advocacy at OIC.

What if I need to see a provider that's not in my health plan's network?

Many of  the health plans for sale in Washington's new Exchange - Wahealthplanfinder - have narrower provider networks. This trend helps keeps premiums down, but it can be confusing and upsetting to consumers who are used to seeing certain providers.

If you don't qualify for a subsidy and you want a broader selection of providers, you may want to consider buying a health plan outside of the Exchange. You can do so by contacting a health insurer directly or an insurance agent can help you. Here's a list of all plans available inside and outside the Exchange by county. Make sure you check the plan's provider directory before you sign up.

Consider these tips on network issues to consider before signing up for coverage.

If you need medical care that cannot be provided by a provider or facility in your plan's network, your health plan must allow you to see the out-of-network provider network at no greater cost than if they were a contracted provider. Read more about your rights to see certain providers.

If you believe you're being treated unfairly by your insurance company, file a complaint with us - we'll look into if for you and make sure your health plan is following the rules.

Want to get more involved? We're currently working on new rules about provider networks. One of the goals is to increase transparency - so you know which providers are covered by your plan and how to access care you need, if they're not. Join our listsev to get updates on this new rule.

Want to work at OIC? We are hiring!

The Office of the Insurance Commissioner has three positions open in its Tumwater office. All are open until filled.

• Financial Examiner 4 (Senior Financial Analyst) to examine and analyze insurance companies and health carrier filings to discern financial condition, difficulties, trends and compliance. This position also supervises three financial examiners in our Company Supervision division. 
• Investigator 4 (Supervisor) to investigate complaints against insurance companies, agents and brokers. This position also supervises seven investigators in our Legal Affairs division. 
• Human Resource Consultant Assistant 2 to help with all things human resources, including working in the state’s Human Resources Management (HRMS) system.

OIC is a small state agency – just over 200 employees statewide – and our mission is to protect consumers, the public interest, and our state’s economy through fair and efficient regulation of the insurance industry. Read more about our agency on our website.

Kreidler orders insurance loan seller to stop doing business in Washington

Washington state Insurance Commissioner Mike Kreidler issued a cease and desist order against Insurance Finance Corp., headquartered in Des Moines, Iowa. The company has been illegally financing insurance premiums in Washington and charging consumers more than allowed under state law.

Essentially, Insurance Finance Corp. sells loans to people who purchase insurance and can’t or don’t want to pay the full premium up front. This type of loan is typically sought by people who purchase commercial insurance policies. Individual policies, including homeowner, renter and auto insurance, typically allow consumers to pay a monthly premium rather than making large yearly or twice-yearly payments.

Kreidler ordered Insurance Finance Corp. to stop doing business in Washington because it violated two state laws – it’s not licensed to do business in Washington and it is overcharging Washington customers. State law limits service charges to $10 per $100,000 per year, and a one-time acquisition charge of $10 per loan.

We identified 429 Washington customers who have purchased loans totaling more than $630,000 from August 2010 through July 2013. However, there could be more customers that we have not identified. We are unable to determine the total amount of overcharges to Washington customers until we can identify all of its customers and loans. Customers may have been referred to the firm by insurance brokers and agents. Washington insurance agents and brokers can help by not referring clients to Insurance Finance Corp. while the cease and desist order is in place.

Insurance Finance Corp. has 90 days to appeal the cease and desist order.

Anyone who sells insurance or insurance products to people in Washington must be licensed by OIC. You can look up a company’s licensing status and see if a company has complaints on our website.