Insurers should be current on emerging treatments for consumers

A growing concern for consumers and health insurers is the cost of prescription drugs and specifically, treatment for debilitating and life-threatening diseases.

Hepatitis C is a good example. New drugs are now used to cure this life-threatening liver ailment with proven success. But the pills are costly, ranging from $55,000 to almost $95,000 per patient for a standard 12-week treatment period.

Two nationwide organizations, the American Association for the Study of Liver Diseases and the Infectious Disease Society of America, now recommend that most patients receive treatment even if they are in the early stage of the disease versus waiting until it has progressed.

Last November, the federal government encouraged states to ensure that health coverage policies are “informed” by the treatment guidelines noted above. Unfortunately we do not have the authority to mandate that insurance companies abide by the guidelines. However, we do expect insurers to be current on all appropriate guidelines that best serve consumers. That is true for all types of treatments.

We recently asked health insurers in Washington if they were aware of the new guidelines and if they were making any changes to how they were treating patients with this disease. The responses were varied, but there were common themes:

• No company excludes treatment.
• All allow testing to detect the disease.
• All recommend that patients consult their doctors on the best course of action.

What’s also evident is that insurers are trying to manage their claims costs. That’s not unexpected. Future prescription drugs for ailments such as multiple sclerosis and high cholesterol are expected to cost even more than the hepatitis C treatment.

The emphasis for insurers, though, should be on ready access to appropriate treatment that leads to a healthier state and nation overall.

If you believe you’ve not getting access to prescription drugs or other necessary treatment, we can help you understand your rights to appeal and even contact your insurer on your behalf.

My insurance premium went up. How can I find out the reason for the increase?

Consumers frequently ask us this question. Your agent or insurer should be able to provide you with an explanation other than “there was a general rate increase.” We recommend that you obtain a policy-specific premium breakdown directly from your agent, and that you ask for a rate worksheet comparison between your old premium and your new premium. 

Every policy is priced differently, depending upon the type of coverage you want and what are called underwriting factors.

Underwriting factors for auto insurance may include:

• Household/family driver records.
• Driver(s) age(s).
• Type of vehicle(s).
• The number of miles you drive per year.
• Where you live and/or drive your car.
• Level of coverage being purchased
• There may be surcharges or discounts unique to your situation.

Underwriting factors for homeowner’s insurance may include:

• The age of your home.
• The materials used to build your home.
• Your home’s value, as based upon its size and features.
• Your home’s location.
• Prior claims or losses for the home.

Read more about understanding auto insurance and understanding home insurance.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

If you find yourself the subject of an insurance fraud investigation, the best thing to do is cooperate

Our consumer advocates respond to thousands of inquiries from Washington consumers each year. Sometimes, we hear from people who are the subject of an insurance company fraud investigation.

Most consumers we talk to are surprised to find out that insurers have the right and responsibility to investigate potentially fraudulent insurance claims. If an insurance company flags a claim as high risk for fraud, consumers are contacted by the company’s special investigations unit (SIU).

Being the subject of a fraud investigation can be unnerving, and many consumers are bewildered and angered by SIU actions of their insurers. Consumers who contact us generally feel the company is infringing on their rights; however, that is not the case. We advise consumers to cooperate with the company’s investigation; most policies state that consumers are required to cooperate with any investigations, or they forfeit their rights outlined in the insurance policy.

Insurance fraud is a crime in Washington state, so if you are being investigated, it’s best to cooperate and provide any documentation you can to support the facts in your claim.

If an insurance company’s SIU finds evidence that a crime occurred, they forward the case to Commissioner Kreidler’s SIU, which conducts an investigation and works with the state Attorney General’s Office and local law enforcement to prosecute people who are suspected of committing insurance fraud.

In 2015, Kreidler’s SIU received nearly 1,700 fraud referrals and obtained 22 felony guilty pleas or convictions. Approximately 10 cents of every dollar consumers pay toward insurance premiums pays for a fraudulent insurance claim.

Read more about Kreidler’s SIU. 

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Medicare offers weight loss program

A new year has started and many of us have set weight loss as a goal. You may be thinking of looking into one of the many weight-loss programs available to consumers. However, if you’re on Medicare, did you know that it pays for obesity screening in some cases as a preventive service?

For people who qualify for the obesity screening, Medicare pays for up to 22 face-to-face intensive counseling sessions during a 12-month period with a primary care doctor who accepts Medicare. Qualifying clients have a body mass index (BMI) of 30 or higher. 

The Columbian newspaper in Vancouver recently featured a medical clinic that provides this service for Medicare recipients.

If you are interested in this service, first you should contact your primary care doctor to see if he or she offers this type of program. You can read more about the coverage on Medicare’s website.

There’s still time to get a health plan for 2016

Consumers have until Jan. 31 to sign up for a health plan for 2016 coverage. People who do not have a health plan for 2016 face a penalty on their taxes of 2.5 percent of their income or $695 per person, whichever is higher. Read more about the tax penalty.

If you are still looking for a health plan, you check our state’s health insurance exchange, Washington Healthplanfinder to find out if you qualify for financial help, including tax credits that may lower the cost of coverage. 

If you do not qualify for help with your health insurance, you can contact an insurance agent or broker directly to find out what your plan options are. You can look at the 2016 individual plans and rates on our website.

Read some tips from us about things you should consider when shopping for a health plan.

After Jan. 31, you’ll have to qualify for a special enrollment period to sign up or make a change to your plan, or wait until the 2017 open enrollment period.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Wednesday is the deadline to get a health plan for Jan. 1

Consumers have until Dec. 23 to sign up for a health plan through Washington Health Benefit Exchange for coverage that begins on Jan. 1. The last day to get health insurance for 2016 is Jan. 31. People who do not have a health plan for 2016 face a penalty on their taxes of 2.5 percent of their income or $695 per person, whichever is higher. Read more about the tax penalty.

If you are still looking for a health plan, you can look for one at our state’s health insurance exchange, Washington Healthplanfinder and find out if you qualify for financial help, including tax credits that may lower the cost of coverage. If you do not qualify for help with your health insurance, you can contact an insurance agent or broker to find out what your plan options are.

Read some tips from our office about things you should consider when shopping for a health plan.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Is there a drone on your shopping list? You might want to talk to your agent or broker

The Federal Aviation Administration (FAA) estimates more than one million drones will be sold this holiday season. Everyone from photographers and farmers to law enforcement and hobbyists are using drones.  Whether for personal or commercial use, there are a number of insurance issues to consider ranging from personal injury and property damage to privacy concerns.

Drones present a significant risk to property and life on the ground in the event of an accident. Drones can crash due to faulty and inappropriate operation, mechanical defects and component failure. Losses and damages could involve bodily injury to humans and animals as well as buildings and structures.

Using a private drone as a hobby is generally covered under a homeowner’s insurance policy—and subject to a deductible--which typically covers radio-controlled model aircraft. This also applies to a renter's insurance policy. Look at the contents section of your policy, or talk to your agent to see if your drone will be covered if it is lost, stolen or damaged. If your drone falls onto your car, damage to your car may be covered if you have a comprehensive coverage auto policy.

A larger concern is liability for an accident caused by your drone. If your drone crashes into someone else's vehicle or a person. If you have a homeowner’s or renter's policy, generally the policy will cover liability for an accident caused by your drone if it is determined that you were negligent and at fault. Check with your agent or insurer to verify your policy contains this important coverage. You can also read a story about drone insurance that was recently posted on the Insurance Journal’s website.

Drones are defined as remotely piloted aircraft systems and the FAA says pilots of unmanned aircraft have the same responsibility to fly safely as manned aircraft pilots. In addition to FAA regulations, state and municipalities may have their own laws regarding drone use.  The FAA has issued these guidelines for drone hobbyists:

• Don't fly higher than 400 feet and stay clear of surrounding obstacles.
• Keep the aircraft in sight at all times.
• Stay away from manned aircraft operations.
• Don't fly within five miles of an airport unless you contact the airport and control tower before flying.
• Avoid flying near people or stadiums.
• Don't fly an aircraft that weighs more than 55 pounds.
• Use caution when flying your unmanned aircraft.
• With some drones weighing up to 55 pounds, a fall from the sky can cause significant damage to property or bystanders.

Recently, federal regulators announced that recreational drone operators will soon need to register their aircraft. This will allow authorities to trace a drone back to the owner, which means it's vital that you're in compliance with laws and regulations and have the appropriate insurance coverage.