'Free cancer test' scam hits Spokane

Last month, we warned about a new scam targeting people on Medicare that's related to genetic testing and cancer screening tests. The scam recently hit Spokane.

KHQ in Spokane aired a story about a woman who got a cold call from a scammer saying she was eligible through Medicare for a free cancer screening test. A swab would be mailed to her, she'd use it and then mail it back. Unfortunately, the woman provided her personal information to the scammer.

Please remember the following tips to avoid becoming a victim of Medicare fraud:

• Do not give out your Medicare number or Social Security number, especially if you are contacted by someone you don't know or have never spoken to before.  If your personal information is compromised, it may be used in other fraud schemes.
• Do not consent to any lab tests at senior centers, health fairs, or in your home. Be suspicious of anyone claiming that genetic tests and cancer screenings are provided free, at no cost to you.
• Genetic tests and cancer screenings must be medically necessary and your doctor must order them to be covered by Medicare. Random genetic testing and cancer screenings are not covered by Medicare. If you're interested in the test, talk to your doctor.
• Monitor your Medicare Summary Notice to see if there are any services you were billed for that you didn’t have or didn’t want. Medicare Summary Notices are sent every three months if you get any services or medical supplies during that three-month period.

SHIBA is Washington state's Senior Medicare Patrol project. If you have a question or suspect fraud or abuse, call us at 1-800-562-6900 and ask to speak with SHIBA.

OIC impersonator contacting auto collision victims

We recently received a report that a marketer is making calls to people who have been in auto collisions impersonating the Office of the Insurance Commissioner to sign people up for chiropractic appointments.

There are several problems with this, starting with the fact that it's illegal.The OIC doesn't cold-call people and we don't recommend specific businesses, whether it be a medical provider, auto repair shop or insurer.

Here are some red flags that someone may be trying to scam you:

• Unsolicited calls from an organization you’ve never been in contact with or heard of before. Traffic collision and police records are available to the public and can be used to market to people.
• A vague or nonspecific business name like “your insurance company,” “insurance commission” or something very broad like “collision consultants.”
• They ask you for personally identifying information. Before you agree to anything or give financial information, ask some questions to try to figure out who the person represents. Do not give your insurance policy number bank or credit card information. It’s not uncommon for people to be trying to steer you to a specific business.

If you get a call of this nature, please report it to us online or by calling 1-800-562-6900. It helps us to have as many details as possible: the caller's name, phone number, organization they represent, time of day they called, place where they referred you.

Spring snowmelt, rain will increase chance of floods, landslides

According to FEMA Region X, most watersheds in Washington are near their average snowpack levels for this time of year. That’s a good thing for the upcoming wildfire season, which started strong this week with 50 fires -- 49 of them in Western Washington, according to Washington State Department of Natural Resources. However, the strong snowpack also increases the risk of flooding as snow melts and spring rain begins.

Snowpack map from USDA/NRCS 

Regions that experienced wildfires in the last three years are especially susceptible to flooding. If you live in one of those areas, you should be alert for flood warnings and you should look into flood insurance. Just one inch of water in the average home can cause more $25,000 in damage. 

Many agents and brokers offer flood insurance policies available through the National Flood Insurance Program (NFIP), which offers protection against flood hazards for homeowners, business owners, condo owners and renters. Typically, there is a 30-day waiting period before your flood insurance policy takes effect.

Excess water can also cause landslides, which are not covered by homeowner or flood insurance. You will need what’s called a “difference in conditions policy” to be covered for a landslide. You can ask your agent or broker about purchasing a difference in conditions policy. Read more about landslide insurance.

Find more information about floods and homeowner’s insurance, including tips for protecting your home and belongings. We also have tips for filing a claim after a natural disaster and how to find disaster resources.

What happens if I total my car?

One of the most common questions we get is “What’s the process now that my car’s been totaled?”

A total loss (the term insurers use) is when a vehicle is in a collision and the insurance company determines it would cost more than the vehicle is worth to repair it, so they “total” it.

Once an insurer declares a vehicle a total loss, they owe you the retail market value of your car, plus sales tax. But how do you know if the amount the insurer offers you is a reasonable estimate of the retail market value? Many consumers don’t know they have the right to, and should, ask the insurance company for a total loss valuation report, which shows the comparable auto data the insurer used to calculate your vehicle’s value. Most insurance companies don’t automatically provide the report to consumers and there’s no requirement that they provide it without being asked.

Insurers can either give you cash for your vehicle’s retail value or offer to replace your vehicle with a comparable vehicle in your area. A quick note about this point -- Washington state law doesn’t allow insurers to look at car values more than 150 miles from your home unless you give them permission. Even if you are dealing with someone else's insurer, they still need to look for comparable cars in and near where the vehicle is normally garaged or parked.

If you have problems with this -- and you live in Washington state -- feel free to file a complaint with our office so we can help ensure that the rules are followed. If you live in another state, check with your state's insurance department.

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

What is PIP and do I need it?

Auto insurance policies sold in Washington state often offer personal injury protection (PIP), which helps pay for certain costs suffered in a collision, including:

• Medical expenses 
• Lost wages 
• Lost services 
• Funeral expenses 

There are also things that it won't cover, including injuries caused when using:

• Farm equipment 
• Off-road vehicles 
• Mopeds 
• Injuries sustained while racing 
• Injuries sustained while committing a felony

Also -- and this is important -- PIP does not cover services that your insurer decides are not:

• Reasonable 
• Necessary 
• Related to the accident 
• Incurred within three years of the accident 

Agents and insurance companies are required to offer PIP coverage, and you must opt out of it if you don’t want it.

Read more about PIP.  Questions? You can contact our consumer advocates online or call 1-800-562-6900.

Little-known database can affect your insurance rates

Most insurance consumers are not aware there’s a little-known database called CLUE—Comprehensive Loss Underwriting Exchange—that can affect consumers’ property and auto insurance rates without their knowledge.

What should consumers know about CLUE?

• It’s a report generated by LexisNexis that contains up to seven years of your personal auto and property claims history. The data comes from insurance companies when they close claims you file. 
• Insurance companies review the CLUE data and use it to set the rates they charge you. 
• You have the right to request a free copy of your report: 

LexisNexis, Consumer Center
866-312-8076
Request your personal report online

If you find mistakes in your CLUE report that you want to dispute, contact LexisNexis Consumer Center at 888-497-0011.

Read more about CLUE.

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

What can I do if my health insurer denies my claim?

It’s not uncommon for a health insurance company to refuse to pay for medical treatment. If it happens to you, it doesn’t have to be the final word.

You can appeal to your insurer. If the answer's still no, you can appeal to an independent review organization. In addition to appealing a denial, you can also file a complaint with us.

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 documentation from your medical provider and information about your medical condition.

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.

Read more information and find letter templates and other pointers in the appeals section of our website. If you need help, file a complaint with us.

What happens if I lose my health insurance?

Health insurance is available only during a short window each year, called open enrollment. This year, open enrollment for individual and family health plans starts Nov. 1, 2019 for coverage to take effect in 2020.

However, certain events qualify you for a special enrollment, including losing your existing health coverage.

If you lose coverage that was provided by an employer, you are eligible to buy a COBRA plan, as well.

COBRA is a federal law that allows you and any of your immediate family members to stay on your employer’s health plan if you lose your job or your employer coverage.

COBRA can be expensive. People who choose COBRA coverage must pay the entire premium, including the portion previously paid by the employer, plus a 2 percent administrative fee.

Before you decide to go with COBRA, find out if you can buy a health plan through Washington Healthplanfinder and receive a subsidy to help pay your insurance premiums. If you don’t qualify for any subsidies, you can also purchase coverage directly from an insurance company, broker or agent.

Other events that qualify you for a special enrollment include:

• Having or adopting a baby.
• Moving to a new area that’s not covered in your existing plan.
• Getting married or divorced.
• A change in eligibility for your existing health plan. 
• Your health plan stops selling coverage in Washington state. 

Read more about special enrollment on our website. Questions? Contact our insurance experts or call 1-800-562-6900.

Consumer alert: What you should know about winter storm damage

A winter storm has hit Washington state hard, with record levels of snowfall in Western Washington and it may not be over yet. Forecasts call for continuing rain or rain/snow mix and possible freezing temperatures overnight in some areas.

A state trooper helps a motorist dig out
after sliding off the road on Highway 3 on Feb. 11.
Photo courtesy Washington State Patrol

Here are some tips about winter storm prevention and damage.

Auto damage

If you have comprehensive coverage, your policy should cover any damage caused by trees, ice or other weather-related mishaps. The amount of your deductible may sway your decision to file a claim, depending on how much damage there is.

A good way to avoid a weather-related collision to is leave yourself plenty of time to arrive at your destination and drive slowly. Get real-time tips from Washington State Patrol.

Also, it’s a good idea to park your vehicle in a protected area or away from trees that can damage it.

Boats and RVs

Be sure to check your boat and/or RV is you are storing one outside. Boats moored in marinas need to be checked, as the weight of ice and snow can sink a boat.

Snow/ice

The prolonged weight of ice and snow on buildings can lead to collapse or cause the roof to crack and let moisture in the home. Sometimes these cracks are not apparent, and may not be seen for a few weeks to a few months.

Another issue to be aware of is frozen gutters. If water collects in them and it freezes, it can cause damage to the house. Those claims can be contentious because sometimes the damage isn’t found until much later, so it’s hard to prove what actually caused the damage. To be on the safe side, clear debris from gutters so water doesn’t collect and freeze.

If it is not safe to remove snow or clean gutters, consider hiring a licensed and bonded contractor to do the work.

Snow melt

Some areas of the state are experiencing a rapid snow melt, which is good but may also cause problems for some people. Homeowner’s insurance doesn’t cover flood damage. You would need a flood insurance policy, which has a 30-day waiting period to kick in. So if you don’t have a flood policy and you experience flood damage, you won’t be covered.

Here are some tips for avoiding flooding on your property:

• Pile snow in a place that won’t cause water to flood any buildings as it melts. 
• Try to clear out accessible down spouts and storm drains to prevent backups and overflows. 
• If any of these activities are unsafe, you may want consider hiring a licensed and bonded contractor to do the work. 

Read more about winter weather and insurance considerations. Questions? Contact our insurance experts.

Kreidler helped consumers recover $15.9 million in 2018

Washington state Insurance Commissioner Mike Kreidler has a dedicated team of people who help Washington consumers with their insurance questions and  problems every business day of the year.

Here's how we helped more than 82,000 consumers in 2018:

• Received and processed 6,779 consumer complaints, resulting in the recovery of $15,916,013 for consumers related to insurance billings, refunds and various claim-handling issues
• Answered 73,983 calls to our consumer hotline regarding insurance issues, rights and responsibilities
• Answered 2,013 live chat insurance-related questions from consumers 
• Responded to 5,408 written consumer inquiries
• Mailed 1,725 insurance-related publications to consumers upon their request
• Made 1,105 in-person contacts with consumers at public outreach events
• Helped consumers resolve various policy issues, including claims, billing, and underwriting problems, and offered referral services to other state agencies and organizations, including the Washington Health Benefit Exchange

If you have an insurance question or complaint, contact us online or call us: 1-800-562-6900

Kreidler revokes Washougal agent’s license when she leaves her client uninsured

Washington state Insurance Commissioner Mike Kreidler revoked the license of Washougal insurance agent Jacqueline Cone last month when her client was left on the hook for $12,000 in damage after an auto collision.

Cone sold a Farmers Insurance auto insurance policy to a friend in 2017. The friend set up payments through her debit card, but told investigators that she switched to cash payments. In August 2017, Farmers canceled the policy because they never received the premium payments from the agent. In October 2017, the policyholder filed a claim with Farmers after a collision and was told that she was no longer insured. The company had mailed several cancellation notices but the policyholder said she moved and never received them.

The agent and the policyholder both told investigators that the cash payments had been made, but could not prove it. The agent told Farmers she accidentally applied the cash premium payments to the wrong person’s policy. Either way, the agent’s action violates state insurance laws. Farmers fired Cone in April 2018 and Kreidler’s regulatory investigation resulted in revocation of her license to sell insurance in Washington state.

Here are some tips for consumers:

• Pay your premiums in a way that leaves a record or paper trail. You want to be able to prove you paid your premiums. 
• Pay your premiums directly to your insurer – you can set up monthly, biannual or annual premium payments for just about every type of insurance out there. Set it up to come directly out of your bank account or billed automatically to your credit card. There is less chance of a mishap if you cut out the middleman – in this case, the agent. 
• Set up email notifications from your insurer. If there’s an app, make sure your phone is set to receive notifications via the app as well. You don’t want to miss notifications from your insurer that they haven’t received your premium payments. 
• It’s your responsibility to make sure your insurer gets your premium payments. 

Kreidler regulates the insurance industry in Washington state. Each month, he takes enforcement action  against insurance companies, agents, brokers and others in the industry and publishes a news release with those orders. You can sign up to receive email or text alerts with news from Kreidler.