OIC expands online services through NIPR

The OIC has expanded the types of applications we can accept online through our partnership with the National Insurance Producer Registry (NIPR) to new and renewing insurance licenses for: 

• Washington resident insurance producers (full lines only) 
• Washington surplus lines brokers 
• Out-of-state surplus lines brokers

Through our partnership with NIPR, an applicant or licensee can submit multiple applications or renewals to more than one state simultaneously. In today’s marketplace, many insurance professionals hold licenses in multiple states. View a list of applications that may be submitted to OIC through NIPR.

Protect your identity to prevent Medicare fraud

During National Consumer Protection Week, OIC is offering tips to help protect insurance consumers in Washington.

Medicare is the national health care plan for all U.S. citizens age 65 and older. It also covers people younger than age 65 who receive Social Security Disability Income and people diagnosed with specific conditions.

Medicare is a $585 billion program with approximately 48 million enrollees. That number will grow as more baby boomers become eligible for Medicare. Medicare fraud can be hard to track, but some estimate that Medicare fraud accounts for up to 10 percent of its annual budget.

We all pay a price for Medicare fraud, waste and abuse, which contributes significantly to rising health care costs. Here are some red flags to watch for:

• Check your monthly statement for services or equipment you didn’t receive or for prices that seem higher than you expect or were told.
• Never give your Medicare number (which is your Social Security number) in exchange for “free” testing, screening, products or services. Never give your Medicare number to anyone who calls or solicits you. Medicare will never call you.
• A medical provider should never charge you for billing Medicare on your behalf or for filling out forms.
• Medical providers should never who waive your coinsurance or deductible.

View more Medicare fraud tips on our website.

If you suspect Medicare fraud or have questions about your bill, call OIC’s Statewide Health Benefits Insurance Advisors (SHIBA) at 1-800-562-6900 or contact a local SHIBA office.

SHIBA also holds Medicare fraud prevention workshops throughout the state. 

Are you covered for flood damage? The answer may surprise you

This month has been the soggiest March on record in the Seattle area, according to the Associated Press, and some areas of the state are experiencing heavy rain that may cause flooding today and tomorrow. Here are some things that are good to know about floods and insurance:

• Homeowner policies typically do not cover flood damage. Flood damage is not on standard homeowner policies and most commercial policies, although many people assume it is. That can be a costly assumption. Your mortgage lender may require you to have flood insurance if your home is located in a flood-prone area, also known as a "special flood hazard area." You can estimate your property's flood risk online.
• Most people buy flood insurance through the government’s National Flood Insurance Program, which is run by the Federal Emergency Management Agency (FEMA). These policies are sold through local insurance agents and brokers, which you can locate online. As with most policies, there are limits to what is covered.
• Flood insurance rates are in flux. In July 2012, Congress passed the Biggert-Waters Flood Insurance Reform Act, which changed the way the National Flood Insurance Program is run. Among those changes were premium rate increases to make the program more financially stable. However, a new bill is being heard in Congress that would slow the premium increases for certain policyholders. That bill, call Grimm-Waters, passed the U.S. House of Representatives on March 4.
• If your vehicle is damaged in a flood, your auto policy’s comprehensive coverage typically will cover it. However, you should verify you have that type of coverage with your insurance agent or broker. Read more about auto insurance.

You can read more about flood insurance on OIC’s website. 

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.