Guest Editorial: Insurance Commissioner Mike Kreidler
WSDA recently reached out to Washington State Insurance Commissioner Mike Kreidler to find out why filing complaints is important for both consumers and providers.
A dental complaint from last April included language typically found when consumers believe they have been wronged: “Insurance company has declined treatment giving bogus excuses. We have submitted everything they have asked for twice before.”
The complaint involved denial of periodontal treatment. This prompted the consumer’s Bremerton-area dentist to also express frustration: “I EXPECT THIS TREATMENT TO BE COVERED BECAUSE THIS IS THE THIRD TIME WE HAVE SUBMITTED EVERYTHING THAT YOU HAVE ASKED. I WARNED YOU THAT I WOULD FILE AN OFFICIAL COMPLAINT.”
What initially seemed like a clear-cut case eventually revealed a need for the dentist and insurer to clarify the necessary medical evidence. Within three weeks, the consumer received treatment, thanks in great part to the excellent work of an experienced advocate in my Consumer Advocacy program.
The advocate served as the go-between, asking questions, reviewing documentation, and getting answers.
It’s work that occurs on a daily basis in my office. We manage about 6,000 consumer complaints annually. These cover a vast array of insurance-related issues. More than 100 of them in the last year involved complaints about dental services. Most were for initial claim denials and payment issues.
There are 10 key reasons why people should file complaints with my office:
1. We want them
The mission of the Office of Insurance Commissioner is to protect consumers. Filing a complaint is the most important way to put a spotlight on a problem. Laws and regulations allow us to delve into issues in ways an individual cannot. Insurance companies pay attention when we call or write.
2. Proven process
Our consumer team follows step-by-step procedures. Advocates make an initial assessment to quickly determine the appropriate course of action.
3. Saves you time
A knowledgeable advocate can quickly get to the heart of an issue and may be able to address the consumer’s concerns by simply answering questions.
4. We know our limits
My consumer advocates do not offer legal advice, act as attorneys, or force an insurer to take action if no laws are broken. And they don’t make medical judgments.
5. We’re not the cable company
When consumers call our office, they talk with a real person instead of working through a menu of options that may leave them frustrated.
6. We have legal muscle
My office can take enforcement action against a licensed person or insurance organization, if warranted. We can discipline and fine bad actors for proven misconduct. More serious harm can lead to suspension or revocation of insurance licenses.
7. We dig deep
Responses we receive often address matters not previously known. This can be particularly valuable when the claim is small. If a consumer considers taking legal action, the information that a complaint generates may prove useful in determining whether litigation is appropriate.
8. Complaints are revealing
Data generated helps us spot trends. Analyzing complaints may reveal practices that require a regulatory response that goes beyond disciplinary action.
9. We do a great job
In 2015 alone, our advocates helped consumers recover over $9 million related to insurance billings, refunds, and claim-handling issues.
10. It’s easy to do
You can contact our consumer advocates at 800-562-6900 or file a complaint online any time or day of the week.
Mike Kreidler is currently serving his fifth term as Washington’s Insurance Commissioner. For more about the office’s work, read the 2015 annual report.