Friday, January 31, 2014

What types of health information are consumers compelled to divulge under Affordable Care Act rules?

I just selected a new health insurance plan and they’re asking me questions about my health. I thought insurance companies can’t do this anymore?

Under health care reform laws, insurance companies can’t require you to answer health questions in order to buy insurance.

However, once you are covered by a health plan, companies are allowed to ask questions to determine whether you qualify for one of their disease management programs or for case management services. Disease management programs help consumers learn how to manage chronic health conditions such as diabetes, heart disease, or depression.

Case management programs help consumers who have very serious health conditions, such as leukemia, cut through the red tape to get the insurance company to pay for their treatment. For example, to prevent misdiagnosis, some insurance companies won’t start paying for cancer treatment until consumers get a second opinion to confirm the diagnosis. The average consumer wouldn’t know this, but a case manager will tell the consumer about this requirement and, if necessary, help the consumer schedule an appointment for a second opinion. Many case managers are also licensed nurses, so they can also suggest solutions to problems, such as side effects, that consumers experience during treatment.

Both of these services are voluntary, so you don’t have to answer the questions. Even if you do answer the questions, you don’t have to participate in the programs.

I recently applied for life insurance and they made me answer questions about my health. I thought insurance companies can’t do this anymore?

Under health care reform laws, insurance companies can’t require you answer health questions in order to buy medical insurance. However, insurance companies can still require to you answer health questions to buy other types of insurance, including:

  • Life insurance 
  • Long-term care insurance 
  • Dental insurance
  • Vision insurance 
  • Disability insurance
  • Medicare Supplement plans and Medicare Advantage plans, under certain circumstances

Read more information about health care reform.

Our consumer experts can answer your questions about any type of insurance. They are available by phone at 1-800-562-6900 or by submitting an inquiry through our website.

Thursday, January 30, 2014

Kreidler: Nearly 14.5 percent of Washingtonians were uninsured in 2012

Today, we issued our fourth report on the number of Washingtonians who have no health insurance. At the end of 2012, some 990,000 people -- approximately 14.5 percent of the state's population -- were uninsured.

From 2010 through 2012:
  • The number of uninsured people in Washington grew by more than 44,000.
  • Four out of five people with individual insurance were underinsured, meaning they had plans that only paid for 25-40 percent of their medical costs.
  • Employer-sponsored coverage grew increasingly scarce.
  • Uncompensated care ballooned to nearly $1 billion per year.
The Affordable Care Act fully took effect on Jan. 1 and the uninsured rate is expected to drop to 6 percent by 2016. Early provisions of the Affordable Care Act prevented an estimated 100,000 people from joining the ranks of the uninsured prior to 2014.

“For many families who have struggled to get or keep health coverage, health reform couldn’t come soon enough,” said Insurance Commissioner Mike Kreidler. “Regardless of how you feel about ‘Obamacare,’ it’s hard to argue that we’re not making progress in stopping the growth of uninsured or that the status quo was sustainable. Before health reform, we had hundreds of thousands of people living one bad diagnosis away from bankruptcy.”

Wednesday, January 29, 2014

Food for thought when planning Super Bowl party

If your Super Bowl party gets out of hand or you find yourself with an unruly guest, our consumer advocates shared a general overview of what your homeowner insurance may cover. You should check your own policy to find out exactly what you are covered for.

If someone is injured at your home

Generally, homeowner policies have two types of coverage that could apply.

Premises medical (guest medical) is designed to cover medical expenses (each policy has its own limit) that occur from an on-premises, accidental injury. Premises medical is a more direct payment method to pay for, or reimburse, the injured guest for related medical expenses.

Liability would cover an injury to a guest if the homeowner was found to be negligent, and the negligence was the cause of the injury. For instance, if a homeowner failed to repair a falling-down porch and a guest was injured on it, the liability portion of the policy could cover the injury.

If a guest causes damage at your home

If an unruly guest damages your home or your belongings—such as a beer bottle launched at the TV after a bad play—it might be classified as vandalism and covered by your policy, subject to the policy deductible. The homeowner’s insurer may seek collection action against the unruly guest for reimbursement. The guest may have his or her own homeowner policy that includes liability coverage; however, it would likely not apply because intentional acts are excluded from personal liability coverage.

If you have renter insurance, check your policy for what type of damage is covered and check your lease for what type of damage you are responsible for.

Be prepared for guests

Any time you invite guests to your home, whether it be a Super Bowl party or any other gathering, it’s your responsibility to ensure your home is safe and that your guests are reasonably safe. That includes being responsible with providing alcohol to your guests, making sure there are no obvious hazards and generally taking the same precautions for your guests’ safety as you do for your own.

Before the game, talk to your insurance agent about what is and what is not covered in your policy.

You can find more information about home insurance on our website.

Enjoy the Super Bowl and go Seahawks!

Monday, January 27, 2014

What to do if you haven’t received your proof of medical insurance

Some Washington health-care enrollees have not yet received proof of their insurance coverage. As a result, many consumers are unsure if their medical treatments are covered. If you recently bought a plan, but still haven’t received proof of insurance from your insurance company, Insurance Commissioner Mike Kreidler offers these tips.

Since open enrollment began on Oct. 1, insurance companies have encountered multiple problems that have prevented them from being able to enter new members into their systems. Some companies received incomplete or incorrect information from the insurance marketplaces. Other companies were overwhelmed with the number of applications they received and were unable to process them by the time the new plans went into effect. This delay in providing proof of coverage has many consumers worrying if they really have insurance and wondering what to do next.

Contact the company
The first thing you should do is contact your insurance company to verify that you do have insurance coverage. Ask your company for proof of coverage, such as an insurance card or identification numbers. When you speak to your company, take detailed notes of the conversation. Include the date and time that the conversation took place, and the name of the representative you speak to. Keep copies of any written communication you receive, such as emails or letters. You may need these materials later.

If you are not sure how to contact your plan, our website has contact information for each of the insurance companies that sells plans through Washington Healthplanfinder.

You should also verify that you have paid your first premium on time. Some insurers have permitted late payments for coverage retroactive to Jan. 1. Find out your insurer’s deadline and keep any records that can serve as proof of payment.

If you are about to buy coverage from Washington Healthplanfinder, print any paperwork or confirmations that you receive during the enrollment process.

If you know you don’t qualify for a subsidy through Washington Healthplanfinder, you may find it easier to buy insurance directly a broker or an insurance company. Here’s a list of the plans that are available in Washington.

Remember, 2014 open enrollment for most plans ends on March 31.

Payment options
You may need to get a prescription filled or see your doctor before you receive your insurance card. Your medical provider (hospital, doctor, pharmacy) may be able to verify your coverage by contacting your insurer directly. If they cannot verify your coverage cannot be obtained, you still have options.

One option is to pay for expenses out of pocket. Once your insurance coverage is established, your insurance company should reimburse you in accordance with its established fees for services, minus any deductibles and copayments you are responsible for.

You may also be able to work with your doctor’s office, hospital or pharmacy to delay payment or set up a payment plan until they can verify that you’re insured. Keep your receipts and any bank statements that show that you’ve paid for the services.

More information
The Insurance Commissioner doesn’t administer Washington Healthplanfinder, so if you purchased insurance there, your best bet is to contact their customer service staff if you have questions about whether you are covered.

Friday, January 24, 2014

Insurance Commissioner's 2014 legislative priorities

The 2014 legislative session started on January 13. It’s a short session, scheduled to conclude March 13.

This year, the Office of the Insurance Commissioner has two important legislative priorities.

Insurance Company Solvency (HB 2461)
We're seeking to adopt two model acts created by the National Association of Insurance Commissioners (NAIC) in response to the global financial crisis.

One, called the Holding Company Act, enhances our ability to oversee, monitor and regulate any company under a parent company or holding company system. It must be adopted by Jan. 1, 2016, or Washington state risks losing its NAIC accreditation. This model act aims to improve transparency and accountability of companies and conglomerates that own insurance companies. The legislation would also prevent firms from circumventing regulation designed to protect against financial shell games that could result in insolvency.

The other is called the Own Risk and Solvency Assessment (ORSA) Model Act and requires companies to create a plan for self-assessing and reporting their current and future financials in light of their two- to five-year business plans.

Alien Insurer State of Entry (HB 1402/SB 5489)
This bill modernizes the terms under which international insurance companies could enter the U.S. insurance market through Washington state and requires them to meet the same financial-strength standards and play by the same rules.

K-12 Data Study Funding Restoration
The Legislature passed SB 5940 in 2012, requiring our office to annually study and report on K-12 employee benefits. The original bill included an appropriation of $1.3 million, but the funding was cut last year to $300,000. Without restored funding, we cannot complete the study. This bill restores the funding to its original appropriation.

We post this information on our legislative priorities page.

Public comment on bills
The state Legislature’s website has a new feature that allows citizens to comment on bills. All comments are emailed to all state legislators. If you are interested in commenting on these bills or any others that are being considered, you can search for the bill and select “comment on this bill” next to the bill number.

Thursday, January 23, 2014

Does homeowner insurance pay for fixing a botched home repair job?

My contractor did poor repair work on my home, and my insurance company won’t pay for fixing the work. Doesn’t my insurance have to pay for it?

Consumers often ask us about this. Unless your insurer gave you no choice but to use its recommended contractor(s), the answer is no. If you chose the contractor, then the resolution will be between you and the contractor. If the contractor does not fix the work, then you may need to seek legal advice about your options. Generally, a contractor will try to resolve such issues, so we recommend that you first try to work it out with your contractor.

By the way, the situation is the same for auto repairs. If you chose the repair shop, then resolution needs to be between you and the shop. If you chose a shop recommended by your insurer, then we would expect your insurer to help you resolve the issue.

Learn more about understanding home insurance or auto insurance.

You can report consumer issues to our experts at 1-800-562-6900 or by viewing Talk to an Insurance Expert.

Monday, January 20, 2014

'Ignore the hype' about health care reform is good advice

While the rollout of the Affordable Care Act has not gone as smoothly as hoped for, the doomsday talk is something that should be considered with a good helping of skepticism.

That’s the word from insurers. "Don’t believe the hype: Health insurers think Obamacare is going to be fine" is the recent headline from the Washington Post. Bosses at some of the big-name companies said they expected the initial stages of health-care reform to be rocky. They stress patience.

That’s the same message that Commissioner Kreidler delivered to Congress about five weeks ago when invited to testify before a House health-care subcommittee.

And when asked Jan. 17 by the host of Northwest Now about any concern in our state about the enrollment of the "young invincibles" – people under 30 – Kreidler, the nation’s longest-serving elected insurance commissioner, again urged patience. Two to three years of experience are needed to make informed judgments, he noted.

Learn more about what the commissioner had to say during his interview about health-care reform at KBTC’s Northwest Now website..

Wednesday, January 15, 2014

Exchange launches new plan to reach young uninsured

The Seattle Times covers the Wahealthplanfinder's new plan to reach the young uninsured through a partnership with global concert promoter, Live Nation. Read about the plan to bring enrollment opportunities to concerts, festivals and other events across the state.

Tuesday, January 14, 2014

Enrolled in the federal High Risk Pool? You've got two extra months to find coverage

The federal government announced today that it was extending the deadline for people enrolled in the federally-run Pre-existing Condition Insurance Plan (PCIP) to find new coverage. Consumers in this program now have until March 31, 2014 to find new insurance.

If you're enrolled in this plan, expect to get a letter in the mail explaining the new deadline and details on cost-sharing.

Get more information about PCIP.

Friday, January 10, 2014

Even doctors want to know what health plans they are in

Striking a balance of price and reasonable access to quality medical care is an evolving issue nationwide, Insurance Commissioner Mike Kreidler told a leadership gathering of the American Medical Association on Jan. 10.

The key topic for the panel on Jan. 10: How insurance regulators, medical providers and insurance companies can guarantee patients access to quality care.

Several of the larger health insurers kept their rates down by limiting their provider networks,” Kreidler said during a panel discussion at the AMA’s 2014 State Legislative Strategy Conference in Tucson, AZ.  “This has upset both consumers and providers.”

Kreidler said that he noticed a trend by insurance companies last summer to develop “narrower networks” of doctors and hospitals in the new health plans they offered for the first time on Washington’s Health Benefits Exchange, which manages the Washington Healthplanfinder.

That’s the online site where consumers can shop for 46 health plans and, in many cases, get subsidies to help pay for premiums.

Consumers can also choose from 51 plans in the outside market, where subsidies are not available. Although narrower networks are found in these plans as well, the concern is more prominent in the Exchange.

In some cases, insurers did not contract with doctors and hospitals that had traditionally been part of their networks. The new business model emerged as a way for insurers to keep premiums as inexpensive as possible for consumers.

This development has raised a red flag for consumers and doctors alike. Kreidler recognized the issue when insurers began filing new plans last year. His office is now developing further guidelines to make sure that consumers have reasonable access to services.

More transparency about which doctors and facilities are included in the plans is another key aspect – for both consumers and the medical community. 

His office has already received many comments from consumer groups, doctors, insurers, Indian tribes, legislators and more. Draft rules will be ready in February and will be open for more public scrutiny.

Kreidler noted that this is just a first step.

 “We want to make sure that we have up-to-date information so that consumers know which networks their doctors are in,” Kreidler said. “Doctors also want to know the networks they’re in. What we want to do is establish a common frame of reference for everyone.”


Wednesday, January 8, 2014

Kreidler to speak on health reform at American Medical Assn event

Insurance Commissioner Mike Kreidler will offer his views at the American Medical Association's State Legislative Strategy event Jan. 10 on how the Affordable Care Act is changing the way insurance companies and medical providers offer services to consumers.

He'll be joined by a panel of experts, including:

·         Dr. Barbara L. McAneny, AMA Board of Trustees (moderator)

·         Margaret E. O’Kane, president, National Committee for Quality Assurance

·         David L. Cusano, senior research fellow, the Center on Health Insurance Reforms, Georgetown University Health Policy Institute

·         Dr. Donald Liss, vice president, clinical programs and policy, Independence Blue Cross and member of the AMA Innovators Committee
Key topic for the group: How insurance regulators, medical providers and insurance companies can guarantee patients access to high-qualify care.

Friday, January 3, 2014

I’m confused--do I have health insurance or not?

December was a very busy – and confusing – month for consumers who tried to sign up for health insurance through the Washington Healthplanfinder.

Ultimately, consumers had a deadline of 11:59 p.m. on Dec. 23 to, at a minimum, create an account in the Healtplanfinder. If you are one of those people, you have until Jan. 15 to complete an application, select a plan and pay the first month’s premium for coverage that will back-date to Jan. 1. For more information, refer to the Healthplanfinder’s frequently asked questions about retroactive enrollment.

If you did not meet the Dec. 23 deadline and you still need insurance, you have until Jan. 23 to select a plan and pay for it to have coverage effective Feb. 1.

Open enrollment for 2014 coverage ends on March 31. People eligible for Medicaid will be able to enroll through the Washington Healthplanfinder all year.

You can read more guidance from Washington’s Health Benefit Exchange in its Dec. 30 news release.

Thursday, January 2, 2014

I paid my first health insurance premium, but I don’t have an ID card. What do I do?

Yesterday, consumers were able to start using their insurance under the Affordable Care Act. Washington consumers can sign up using Washington Healthplanfinder.

While the Insurance Commissioner doesn’t administer the Washington Healthplanfinder, our consumer advocates are hearing from a lot of people who have completed their application and paid their first month’s insurance premium, but haven’t yet received their new insurance card or plan information. People want to know what will happen if they need to use their insurance before they get their insurance card.

Medical providers need your insurance ID number to bill them for your care; they don’t need the actual card. If you paid but do not yet have an ID number, you should contact your insurance plan and ask for that information. Your plan can also tell you when your card will likely arrive. If you feel more comfortable having a card, you can ask your company to tell you how to print a temporary ID card.

If you are not sure how to contact your plan, our website has contact information for each of the insurance companies that sells plans through Washington Healthplanfinder.

If you pay out-of-pocket for medical care because you don’t have ID number, you can submit a reimbursement request to your insurance company.