How to get the most out of your dental insurance

 More than 249 million Americans had dental coverage at the end of 2016, according to the National Association of Dental Plans. Here’s some information about how to get the most out of your dental plan.

Types of dental insurance

• Dental preferred provider organization (DPPO/PPO: These plans are popular because they allow covered consumers to choose from an array of dentists and dental specialists. The flexibility of PPOs trends toward higher costs for that type of coverage.
• Dental indemnity insurance: Consumers pay dentists directly for services rendered and later receive compensation from the insurance company through a sometimes lengthy claims-submission process.
• Discount dental/dental savings plans: Dentists agree to perform services for plan owners at a discounted price. Dentists are paid the discounted rate directly by the plan owner.

What dental insurance covers
Individual policies typically cover the following at 100 percent::

• Preventive care: Cleanings, routine office visits 

Most plans apply a copay for these services:

• Restorative care: Fillings and crowns. 
• Endodontics: Root canals
• Oral surgery: Tooth removal, tissue biopsy and minor oral infection drainage.
• Orthodontics: Braces and retainers; sometimes are covered via a rider for both individual and group policies. 
• Periodontics: Scaling, root planning and acute infection and lesion management 
• Prosthodontics: Dentures and bridges 

Make sure you read your policy, including the exclusions and limitations. Your insurance company will not provide benefits for excluded services even if approved, prescribed, or recommended by your dentist.

Learn more about dental insurance. 

Dental coverage for kids and seniors

Dental coverage for kids up to age 19 (also called pediatric dental insurance) is an essential health benefit under the Affordable Care Act. State law requires individual and small group health plans to cover these services, either as part of the health plan or through a separate stand-alone pediatric dental plan.

Medicare does not cover dental procedures. However, some Medicare Advantage plans may offer some form of dental benefit.

More information

There are varying costs for dental procedures, but you can get an idea for how much a procedure will cost you on FAIR Health Consumer's Dental Cost Estimator.

Our office regulates dental and other types of insurance. If you have questions about your coverage, contact our consumer advocates online  or call us at 1-800-562-6900.

New Medicare cards are coming starting in April

 The Centers for Medicare & Medicaid Services (CMS) will start mailing redesigned Medicare cards to beneficiaries in Washington state after June 2018. The new card contains a unique, randomly assigned number that replaces consumers' Social Security numbers. The purpose is to prevent fraud, combat identity theft and safeguard taxpayer dollars. All replacement cards should be delivered nationwide by April 2019.

Here are 10 things to know about your new Medicare card:

1. Mailing takes time: Your card may arrive at a different time than your friend’s or neighbor’s.
2. Destroy your old Medicare card: Once you get your new Medicare card, destroy your old Medicare card and start using your new card right away.
3. Guard your card: Only give your new Medicare number to doctors, pharmacists, other health care providers, your insurers, or people you trust to work with Medicare on your behalf.
4. Your Medicare number is unique: Your card has a new number instead of your Social Security Number. This new number is unique to you.
5. Your new card is paper: Paper cards are easier for many providers to use and copy, and they save taxpayers a lot of money. Plus, you can print your own replacement card if you need one!
6. Keep your new card with you: Carry your new card and show it to your health care providers when you need care.
7. Your doctor knows it’s coming: Doctors, other health care facilities and providers will ask for your new Medicare card when you need care.
8. You can find your number: If you forget your new card, you, your doctor or other health care provider may be able to look up your Medicare number online.
9. Keep your Medicare Advantage card: If you’re in a Medicare Advantage plan (like an HMO or PPO), your Medicare Advantage plan ID card is your main card for Medicare – you should still keep and use it whenever you need care. However, your medical provider may also ask you to show your new Medicare card, so you should carry it too.
10. Help is available: If you don’t get your new Medicare card by April 2019, call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. You can also find help in Washington state from SHIBA advisors in your area by calling 1-800-562-6900 or online. 

Information for TRICARE members in Washington state

 Our office regulates insurance, but not every kind of insurance. One of the types of insurance we don’t regulate are military health plans, such as TRICARE, which is regulated by the U.S. Department of Defense. However, we occasionally receive complaints, calls, and email inquiries from military members and retirees about those plans.

On Jan. 1, TRICARE’s contracted insurance provider changed from UnitedHealthcare Military & Veterans to Health Net Federal Services. We have heard from some consumers and the TRICARE West Region that their call center is experiencing higher volume of calls with long wait times, enrollment backlogs, referral and authorization processing backlogs, and limited network provider directory & delivery issues.

While we are unable to assist in resolving military health plan complaints, we do have information that may help some people:

• TRICARE West customer service number: 1-844-866-9378
• Inquiries regarding West Region claims with dates of service prior to January 1, 2018 should be directed to UnitedHealthcare Military & Veterans. For all other inquiries, contact Health Net Federal Services at 1-844-866-9378 or go to its online portal.
• Consumers may file a complaint online with TRICARE.  
• For more details about the transition from UHC to Health Net Federal Services, see the FAQ for Beneficiaries. 
• If you decide to contact your Congressional representative, be sure to include TRICARE West’s response to your inquiry. If they advise you to contact your state’s insurance commissioner, let them know that we do not regulate your insurer. 
• Find health care information for veterans from the OIC.

If you have questions about another type of insurance – auto, renter, homeowner, or another type of property, you can talk to a consumer advocate by calling 1-800-562-6900 or contact us online.

Insurance fraud hurts consumers, too

 The Office of the Insurance Commissioner investigates criminal insurance fraud, receiving approximately 2,000 referrals each year. While insurance fraud may seem like a “victimless” crime – insurance companies carry large reserves of money in part to help pay claims – it actually harms consumers. Insurance fraud costs the average family $400 to $700 per year in increased premiums.

The OIC’s Criminal Investigations Unit (CIU) is staffed by law enforcement and criminal analysts who work with state and local prosecutors to bring charges against the people who are suspected of committing insurance fraud.

In 2017, our fraud investigators:

• Analyzed and prioritized 1,896 fraud referrals.
• Opened 102 criminal investigations and closed 93 criminal cases.
• Submitted 33 complex criminal cases to county, state, and federal prosecutors.
• Our work resulted in 33 criminal guilty pleas or convictions from 28 defendants.

Here are some examples of insurance fraud:

• Buying insurance after you need it: Getting a policy after an accident or after a loss has occurred. We see this most often with auto collisions. 
• Falsifying claims on homeowner or renter insurance: Claiming items that you didn’t actually own or falsifying the circumstances to increase the damage and the claim amount. 
• Staging car crashes, intentionally causing car crashes (driving slow so someone rear-ends you), submitting fake medical bills after a collision, claiming a car was stolen. 
• A medical provider billing for services or equipment that the consumer did not receive.
• An insurance producer (agent or broker) holding onto consumers’ premium payments or selling fake policies to earn commissions.

Consumers can help deter insurance fraud in a few important ways:

• If you see something, say something – if someone tries to rope you into a scam or tries to make you or someone you know the victim of a scam, report it to us.  
• Make sure you are working with a licensed insurance producer, and check their complaint history on our website. 
• Read your policies, statements and explanations of benefits forms. The best way to not be a victim is to know what your policy covers, how much you are paying, and the claims your insurance company is paying on your behalf. 
• The chances of getting away with insurance fraud are slim. Insurance companies have sophisticated data systems that immediately flag suspect claims. People who are convicted of insurance fraud and related crimes often become felons, which means you lose some of your rights like voting, traveling to certain countries, and some public benefits. 

Consumer complaints can lead to investigations, legal action against industry

 Consumers can file complaints against insurance companies or against an agent or broker (they are called producers). Sometimes those complaints spur broader investigations where we identify a bigger issue.

That’s where our regulatory investigations unit comes in. We have nine investigators who come from military and civilian law enforcement, and one former insurance producer. The team investigates insurance producers in Washington who violate state insurance laws and rules. If the producer is from another state, we refer the case to that state’s insurance department. We also work closely with our own Criminal Investigations Unit and local law enforcement agencies.

In 2017, our regulatory investigators closed 188 cases, ranging from producers illegally selling insurance without a license to complex cases like annuity scams that target older consumers.

Here are some examples:

• A simple complaint about a car rental company selling personal accident insurance resulted in an investigation that determined the company had sold 9,054 unauthorized personal accident insurance policies to consumers without being licensed. Our investigators determined the company earned $615,475.60 from the unauthorized sale of these policies. The insurance commissioner fined the company $45,000. 
• Discount Tire sold more than 1.2 million unauthorized tire warranties to customers in Washington state. Discount Tire is not licensed to conduct insurance business in Washington state, and made over $32 million in sales from these unauthorized warranties between 2014 and 2016.  
• While investigating an insurance agency suspected of employing unlicensed employees to sell insurance, one of our investigators posed as a consumer. The investigator worked with an unlicensed agency employee to fined and negotiate an insurance policy. The agency later denied the practice of employing unlicensed producers, not realizing it had had attempted to sell insurance to an OIC Investigator. The insurance commissioner fined the agency $500 for the violation.  
• A consumer who had a language barrier bought a life insurance policy to cover future funeral expenses. When her husband passed away, the insurance wouldn’t pay the death benefit because her husband had a pre-existing health condition. One of our bilingual investigators worked with the consumer to find out what happened -- the insurance producer failed to ask her the required health questions on the insurance application. Upon review of the insurance application, our investigator found it was not possible to accurately translate the questions for consumers who don't speak English. The insurance commissioner fined the producer and the consumer received a settlement from the insurance company. 
• A Washington consumer filed a complaint with the insurance commissioner about an annuity. The consumer asked the insurance producer for an annuity with socially responsible investments and she wanted complete access to her funds. The insurance producer sold her an annuity that allocated 20 percent of the funds to oil and gas investments and made none of the funds available to the consumer. The consumer requested a refund on the annuity; the producer, brokerage and the company declined to refund her money. As a result of the insurance commissioner’s investigation, the producer’s license was revoked, the agency was fined $2,000 and the company was ordered to refund the consumer for the annuity plus 8 percent annual interest and pay a $20,000 fine for violating state insurance laws.

If you have a question about your insurance policy, agent or company, you can find us online or call us at 1-800-562-6900.

Free, unbiased health insurance counseling is available in all areas of Washington state

 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 Medicare coverage benefits, options and rights.
• Determine your general eligibility for programs that can help you pay for your Medicare.
• Evaluate and compare health insurance plans.

In 2017, our 400 SHIBA volunteer advisors helped more than 108,000 people understand Medicare. Advisors are available in communities throughout the state; find one near you.

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. 

Need more help? Call our Insurance Consumer Hotline at 800-562-6900 or find help online.

It's National Consumer Protection Week -- we are here to help with insurance

 National Consumer Protection Week is March 4-10 and the Office of the Insurance Commissioner is one of many state agencies that help Washington consumers.

This week, we’ll highlight some of the ways our agency helps consumers. Follow along on social media; you can also subscribe to our blog by email or text.

Most people have at least one type of insurance, whether it be health, home, auto, renter, business or another policy. Our consumer advocates are available Monday through Friday from 8 a.m. to 5 p.m. to answer questions about insurance, help you find information and resources about insurance, or help resolve disputes with your insurance company.

Here are some examples of ways we’ve helped consumers recently:

• An insurance company delayed a total loss claim for a consumer whose vehicle was damaged in a collision.
• A consumer was airlifted to a hospital and the health insurance company denied the bill for the air ambulance. We helped the consumer get the insurance company to pay the claim in full, worth more than $30,000. 
• A consumer reached out to us with concerns about a life insurance policy. We recommended the client file a complaint with our office against the insurer. We worked on their behalf, resulting in the consumer receiving a check for more than $100,000.
• A house fire caused more than $100,000 to a consumer’s home. We helped the consumer work with the insurer to cover the damage and pay to replace the contents that were lost. 

In 2017, we helped recover $18.9 million for consumers related to claims, refunds and billing issues.

If you need help with an insurance question, here’s how you can reach us:

• Call us at 1-800-562-6900 or get help online. 
• File a complaint against an insurance company or agent. 
• Find a list of agencies that participate in Consumer Protection Washington.