Special Report: When Consumer Protection Isn’t There III: WE WON and Comment Period on Essential Health Benefits Ends April 22.

 We won!!   Thanks to an intrepid staff attorney at the  Washington State Office of the Insurance Commissioner (OIC).  Esther and I had given up all hope that she would be reinstated with her long term care insurance company  when  Alan Michael Singer somehow found the case and convinced the OIC to take another look Esther’s case.  They took it on and Alan won Esther’s reinstatement!

Alan had actually won a comparable case with another long-term care insurance company, Ability. After he concluded his work on behalf of the OIC against Ability, Ability was fined $10,000, the fine maximum allowed and they had to cease marketing in Washington State for six months.

I have been working with Esther since July 2012 to help her be reinstated.  The complete story is in earlier blogs: When Consumer Protection Isn’t There I and II. http://oconnorreport.com/?s=when+consumer+protection+isn%27t+there

Briefly, Esther had missed some premium payments when she moved. When she discovered her error,  she tried to pay the balance due, and the company told her that her policy had lapsed.  She had paid nearly $40,000 to the company over twenty years. The company had refused to reinstate her policy  even though they knew where she had moved because they evaluated and approved the facility and its health care center. We could not have won this case without Esther’s excellent records.

Most importantly, we could not have won this without the dedication and tenacious determination of one OIC staff attorney:  Alan Michael Singer.

Becasue of working on this case, I am stunned at the lack of consumer protection in cases like this.  Health insurance and probably most insurance is regulated at the state level.  That means enforcement/regulations vary state by state as do the laws.  The implications for consumer protection are staggering as we move forward with health care reform.  We will be writing extensively on this issue as health care reform moves forward.

Some states are already saying they will not enforce the ACA provisions.  This is a very serious consumer protection issue. Follow us and keep up with the rapidly changing health care landscape.  Also stay tuned to how we evaluate technologies that come on the market as we continue our technology series later this week.

Job more than well done, Alan!  Job very well done!

Comment Period on Washington State Essential Benefits Scope and Rules Ends on April 22

http://www.oic.wa.gov/laws-rules/legislation-rules/proposed-new-rules/documents/2012-17102-5.pdf

Submit written comments to:  Meg L. Jones , P.O. Box 40258, Olympia WA 98504

or e-mail rulescoordinator@oic.wa.gov

Fax: 360-586-3109 by (date) April 22, 2013

Public Hearing:  Tuesday, April 23rd at 1 pm:  Training Room T-120, OIC Office, 5000 Capital Way, Tumwater, WA

Kathleen O’Connor © April 12, 2013

About Kathleen

Kathleen O’Connor: 30+ year health care consumer advocate, non-profit executive and author. For more information about Kathleen, please see "About" on the main content bar above.
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One Response to Special Report: When Consumer Protection Isn’t There III: WE WON and Comment Period on Essential Health Benefits Ends April 22.

  1. Gerald W. Roller, MD says:

    Great work…I have had some patients in the past that had similar problems but
    were able to get reinstated because it was less than 90 days.
    We will be visiting Seattle in 2 weeks from now…our daugher, M iriam Molver ( mrs. Jack) live nearby.
    Best wishes…Gerald

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