New report: Fixed-payment insurance policies decreasing in Washington state

Fixed payment insurance plans pay a specific amount -- $25 per doctors visit, say, or $200 a day for a hospital stay -- regardless of the bill. The patient pays the rest.

Plans like this allow employers a way to buy minimal coverage for employees. But it's not comprehensive health insurance. The medical bills may be much more than what the plan pays out.

Each year, we survey fixed-payment companies doing business in Washington state, and compile the results into a report on fixed payment insurance plans.

Here's what we're seeing:

• Sales for group policies have decreased significantly, as has the number of group enrollees. (Group enrollees decreased by 88 percent.)
• Among individual plans, the number of policies and enrollees both decreased.

The full report -- click on the link above -- includes a breakdown in the number of policies sold by each company.

Have a serious medical condition and need health insurance?

Do you have pre-existing condition and need health insurance? Here’s how the new federally-funded Pre-existing Condition Insurance Plan helped a local Olympia man:

Dusty of Olympia, is a 28 year-old with lymphoma. When he was 25 he started his own business. In order to save money he chose not to purchase health care insurance - like others of his age, he felt he could take the risk. Six months later he was diagnosed with stage 4a lymphoma. He received treatment and owes over $200,000 in medical bills. He hadn’t been to the doctor in months because he could not afford any treatment that may be recommended and didn’t want to add to his debt.

Dusty learned about the new Pre-Existing Condition Insurance Plan (PCIP-WA) from one of our employees who met his girlfriend. Today, he’s enrolled in PCIP-WA and finally receiving the care he needs. Here’s what he had to say about the plan:

“As of this July this year, I’ll have been in remission for three years. The
Pre-existing Condition Insurance Plan lets me get all of my tests and everything
is showing that I’m still clear. Life is going really well! My partner and I are
expecting a baby in August and we’re excited.”

If you have a pre-existing condition medical condition and need health insurance – or know of a family member or friend in need, tell them about PCIP-WA today.

Who can apply?
How much does it cost?
How does the plan work?

Apply today!

How to look up info on your agent or broker (plus the answer to the quiz)

Last week we posted a quiz question: How many agents and brokers are licensed in Washington state?

Out of three choices, about half picked the right answer: 118,415.

If you want to check your agent's credentials, find a broker in your area, look for past disciplinary cases, etc., take a look at our new online lookup for agents and brokers.

If you want to also look at company cases, check our insurance disciplinary orders search engine.

Quiz: How many agents and brokers are licensed in Washington?

We've posted a one-question quiz: How many agents and brokers are licensed in Washington state?

You can pick an answer in the poll box, which on the lower right-hand side of this web page.

Check back --we'll post the correct answer in a few days.

More than 1/4 of hospital emergency rooms in non-rural areas have closed in the past two decades

More than a quarter of urban/suburban hospital emergency rooms have closed in the past two decades, researchers have found.

The Journal of the American Medical Association published the study, titled "Factors Associated With Closures of Emergency Departments in the United States." The researchers found that the number of non-rural emergency rooms declined from 2,446 to 1,779 between 1990 and 2009. That's a decline of more than 27 percent.

Health insurance rates, by state

What's an average health insurance premium?

The Commonwealth Fund recently came out with a lengthy report summarizing state trends in health insurance premiums and deductibles from 2003 through 2009. (The upshot: premiums rose 41 percent nationally during those years, while per-person deductibles jumped 77 percent.)

In Washington state, the study found, the cost of premiums rose 38 percent between 2003 and 2009, with family coverage costing an average of $12,758 here in 2009.

How's that compare to everyone else? About in the middle. In a list of the 50 states plus Washington, D.C., from highest family premiums to lowest, we come in 28th.

Also, the Kaiser Family Foundation does an annual survey on employer health benefits. The most recent one -- based on data from January through May 2010 -- found that premiums had risen 114 percent from 2000 through 2010, to a national average of $13,770. Worker contributions during the same time rose -- brace yourself -- 147 percent. (Here's a link to the gigantic full health benefits report.)

Recent cases from our consumer files

Got an insurance question or problem and live in Washington? We may be able to help. (We're the state insurance regulator for Washington.) Give us a call at 1-800-562-6900 or e-mail AskMike@oic.wa.gov.

What kinds of things do we deal with? Here's a sampling of cases from last month:

• We convinced a health insurer to pay an additional $3,000 in surgery claims for a patient.
• We got another insurer to pay more than $10,000 in claims that had been denied due to what the company maintained was a pre-existing condition.
• We helped a Seattle consumer resolve claim delays on his mother's life insurance policy, leading to a $25,000 payment, plus interest.
• When a health insurer repeatedly refused to pay claims because the patient's birthdate on the claim forms didn't match what they (erroneously) had in their records, we got the situation resolved and the claims paid.
• And we helped mediate a dispute over a totaled vehicle's value, meaning that the consumer got nearly $1,000 more than originally offered.

New study: Dog bites account for 1/3 of homeowners insurance liability claims

The Insurance Information Institute, an industry-funded research group, has released a study saying that dog bites account for more than one third of all homeowners insurance liability claims last year.

The total: nearly $413 million, which averages out to more than $26,000 per claim.

The number of claims dropped slightly in recent years, although the cost of the claims rose.

According to the III, there were 15,770 dog bite claims filed last year. According to the federal Centers for Disease Control and Prevention, 4.5 million Americans are bitten by dogs each year, with one in five of those bites needing medical care.

Update: Also, here's a summary of Washington's dog bite liability laws from, yes, the website dogbitelaw.com. (Thanks to Fritz for passing that along, and all these links come with our usual disclaimer: linking ≠ endorsement.)

Seattle woman pleads guilty to insurance fraud

A Seattle woman has pleaded guilty to insurance fraud after claiming $6,503 for auto damage that occurred prior to getting coverage.

Margaret Balderama told Seattle police and her insurance company, GEICO, that she was driving home shortly after midnight on July 5, 2010 when an unknown vehicle hit her 2005 Honda CRV and fled the scene.

She had renewed her auto insurance policy that very afternoon. (It had been cancelled for nonpayment more than 7 months earlier.)

The problem: Area residents told an investigator that they'd seen the car with extensive damage nearly 24 hours earlier than Balderama claimed -- and hours before she called GEICO to renew the lapsed policy.

Balderama pleaded guilty to a gross misdemeanor charge of insurance fraud on April 25th. Sentencing is slated for May 13th.

Free help with insurance complaints, questions and problems

We offer free insurance help to Washington state residents. (We won't try to sell you anything; we're the state agency that regulates the insurance industry.)

You can call us at 1-800-562-6900 or e-mail AskMike@oic.wa.gov. We have staff insurance experts who can answer questions or help you file a complaint about an insurance company or agent.

In many cases, you can even track the status of a complaint online, seeing what we send to the company, their response, etc.

(Not a Washingtonian? Contact your state's insurance regulator.)

Here are some real-life examples of the sorts of cases we've handled recently:

-A business owner near Yakima was hosting a business event, but couldn't get a copy of her insurance certificate from her company. With time running out, she had to buy additional coverage to make sure she was covered. She complained to us, and we got the company to refund the cost of the extra coverage.

-An insurer offered $1,695 for a totalled vehicle. We helped get the consumer $3,250 -- plus tax, title and license fees.

-When a Puget Sound man's trip was delayed, boosting his costs more than $7,000, his travel insurance company paid him $3,266. We got them to boost that by an additional $4,035.

-We helped speed up payment on a delayed claim for a mobile home fire. The amount: $74,362.

University Place man pleads guilty to insurance fraud

A University Place, Wash. man has pleaded guilty to felony insurance fraud after lying about the cause of a Pierce County crash that damaged his Jeep.

Warren Gardinier, 22, was sentenced on April 20th to 40 days in jail (concurrent with an unrelated firearms charge) and ordered to pay court fees and a victim penalty assessment.

On Dec. 9, 2009, Gardinier told the Tacoma Police Department that another vehicle had clipped his red 1996 Jeep Grand Cherokee, causing him to spin out of control, into a fence and then into a tree. He and a passenger sustained minor injuries. The vehicle was insured by his 26-year-old sister for liability coverage only. (Liability coverage will pay for damage you cause to someone else or their property, but not damage you cause to your vehicle or yourself.)

Gardinier called his sister. She called State Farm 36 minutes after the wreck and added uninsured motorist coverage.

Five days later, the two told State Farm the damage stemmed from a hit and run collision Dec. 10. State Farm paid $4,523 for the damage to the Jeep.

Unbeknownst to Gardinier and his sister, however, a witness had seen the crash and called 911. The witness -- who followed the Jeep and got the license plate number -- said there was no other vehicle involved. He said that Gardinier's Jeep had been speeding erratically, fishtailing, and driving off the shoulder and across the road. After several swerves, the witness said, Gardinier's Jeep crashed into the fence and rapidly left the scene.

That 911 call took place before Gardinier's sister called State Farm.

Gardinier's sister agreed to pay full restitution to State Farm. When she has paid that in full, an insurance-fraud charge against her will be dismissed.