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.
الثلاثاء، 2 فبراير 2016
الخميس، 28 يناير 2016
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:
Questions? You can contact our consumer advocates online or at 1-800-562-6900.
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.
- 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.
Questions? You can contact our consumer advocates online or at 1-800-562-6900.
الجمعة، 22 يناير 2016
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.
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.
الخميس، 7 يناير 2016
Medicare offers weight loss program
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.
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.
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