Kreidler on Supreme Court case and the state health-care exchange

Commissioner Kreidler sat down with TVW's Christina Salerno yesterday for a Q&A on health care reform, including this week's three days of arguments in the U.S. Supreme Court and the shape of the state's upcoming Health Benefits Exchange.

From the discussion:

What would change if they overturned the act?

People are directly benefiting from parts of the act today. People can stay on their parents’ insurance until 26, they can get preventive care with no deductibles — all of that would go away. (Attorney General) Rob McKenna’s lawsuit would undo all of that. The entire law may go down. We’d be back to square one, which is a system that’s failing us as a country and as a state. For many individuals, it was making a difference between life or death decisions.

State website access.wa.gov among the top nationwide

Well-deserved kudos to the folks who run Access.wa.gov, a Washington state website that helps make much of what government is doing available on one easy-to-navigate site.

The Sunshine Review, a nonprofit group focused on government accountability, recently awarded the site with an A+ grade, meaning that it's one of the most accessible state government sites in the country. From the group's report card on the site:

Elected officials are listed with contact information
Budgets are posted
Audits are posted
Contracts are posted in a searchable database
The site includes information on requesting public records
Lobbyist lists and reports are posted in a searchable database
etc.

(And a hat tip to The HDC Advance for the heads up on this.)

How to appeal when your health insurer says no

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:

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

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:

• 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)

Thanks for your patience and understanding.

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.

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.

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.

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.

NAIC survey: Most homeowners have no home inventory (and how to easily make one)

The National Association of Insurance Commissioners today released the results of a survey indicating that most Americans don't have a home inventory of their possessions.

The February survey indicated that 59 percent of consumers haven't made a list of what they own. Of those that had, nearly half didn't have receipts. More than a quarter didn't have photos of their property.

Home inventories are a key tool for recovering from a tornado, flood, earthquake or other disaster. They can speed up and dramatically simplify the insurance claims process. They can also help you and your agent decide if you have enough coverage if you have a rare collection or other high-value items. (On average, home contents are reimbursed only up to 50 percent of the home's insured value. In other words, if you're house is insured for $200,000, the maximum contents reimbursement would typically be $100,000.)

Last year, severe weather disasters inflicted more than $43 billion in the United States, according to the NAIC.

How to prepare a home inventory? There are smartphone applications to help. The myHOME Scr.APP.book app lets users capture images, descriptions, bar codes and serial numbers of personal possessions and stores the information electronically for safekeeping. The app organizes information by room and creates a back-up file for email sharing. There's a version for the iPhone and another version for Android phones.

For those without a smart phone, the NAIC offers a downloadable home inventory checklist and tips for effectively cataloguing your possessions.

More consumer tips: Company lookup, agent lookup, and where to look up financials

More tips for National Consumer Protection Week:

How to look up an insurer, including complaint history and disciplinary actions

How to look up an agent, insurance agency, or broker, including complaints and discipline

And how to find the company financial statements that show how your insurance company is doing.

We're the insurance regulator for the state of Washington. Not in Washington? Here's a map with links and contact info for every state's insurance regulator.

Consumer tips: How to look up complaints, available health plans and rate hikes

More tips for National Consumer Protection Week:

-Look up the number of consumer complaints against specific insurance companies

-Buying health coverage on your own? Here's how to find a health plan in your area

-And see if your health plan wants a rate increase.

(We're the state insurance regulator in Washington state. Don't live in Washington? Here's a handy map with links and contact info for your state's insurance regulator.)

Direct Buy Auto Warranty ordered to stop unauthorized insurance sales in WA

For the second time in less than a week, our office is ordering a New York-based company to stop selling unauthorized insurance in Washington state.

This time it's a company called Direct Buy Associates, Inc., although it also does business under several similar names, including Direct Buy Auto Warranty, Direct Buy Warranty, and DirectBuy Warranty. The order also includes AHMT Corp.

Direct Buy Associates and AHMT -- with have adjacent offices on a street in Brooklyn -- do business through websites like directbuyautowarranty.com, directbuywarranty.com and directbuyautowarranty.net. The companies have also listed mailing addresses that include a mailstop in New Jersey, a virtual office in New Jersey, and a European headquarters in Cyprus.

In 2011, we began getting complaints from Washington consumers who had bought plans from these companies. The plans, sold since at least 2009, purported to cover vehicle repairs. The companies sold at least 57 such plans to Washingtonians. At least one Washington consumer who paid the fees monthly was charged international transaction fees from Cyprus.

None of companies or principals named in the order are authorized to transact insurance in Washington. Nor are they registered here as service contract providers.

Our order requires the companies to send copies of the order to all their Washington customers, and to report to us all premiums they've collected for business here.

The order also names a number of individuals, including Albert V. Hakim, Michael A Hakim, R.D. Frazier, Jon Braidsworth and Robert Harrington.

How to file a complaint against an insurance company

Having trouble getting an insurance claim paid? Waiting months?

We can often help. We're the insurance regulator for the state of Washington state, and we field thousands of calls a year from folks having trouble with claims. Last year, we got consumers $8 million in previously-denied or delayed claims.

There are two ways to reach us:

• Our toll-free hotline: 1-800-562-6900.
• Or file a complaint 24/7 with our online filing application.

Important note: If you don't live in Washington state, contact your state's insurance regulator. Here's a handy map with contact info.

It's National Consumer Protection Week - March 4-10

Have you ever had your insurance claim denied or maybe you filed a claim and received less than you thought you deserved. Ever have trouble reading an insurance policy? If you're reading this now, you know about the Office of the Insurance Commissioner and the services we provide. But you probably know a handful of people who've never heard of us.

This week (March 4-10) is National Consumer Protection Week. Tell a friend about our consumer services and follow us on Facebook.

More than 500 people a month file complaints with us. Last year alone, we recovered more than $8.5 million for Washington state insurance consumers who had their claims denied or delayed.

Just in last few months we helped:

• A Redmond consumer get a $29,000 health insurance claim paid


• A Lake Stevens consumer collect an additional $2,553 on an auto claim


• A Rochester consumer get a $7,574 refund on their auto warranty


• A Sammamish consumer get their homeowners policy reinstated

Maybe we can help you! If you or someone you know has an insurance question or complaint, visit http://www.insurance.wa.gov/. We take complaints online and you can track our progress 24 hours a day, seven days a week. Or call our Insurance Consumer Hotline at 1-800-562-6900, Monday-Friday, 8 a.m. -5 p.m.

New York company ordered to stop selling unauthorized insurance in Washington

Update (June 1, 2012): The order has been rescinded. UCAA participated in an investigation of this program and provided information showing that the company had committed no violations.

Our office today ordered the United Consumer Awareness Association to stop selling unauthorized health insurance in Washington state.

The company, a not-for-profit entity incorporated in Missouri, appears to have its home office in Syosset, New York.

The company, which is not licensed to solicit and sell limited-benefit medical insurance in Washington, nonetheless sold policies to 44 Washingtonians.

The order takes effect immediately. The company has the right to demand a hearing.