How to get health insurance if you missed open enrollment

If you missed open enrollment and didn't sign up for health insurance by Jan. 31, 2016, you may have to wait until next year's open enrollment period, unless you have a life event that makes you eligible for a special enrollment or you qualify for Apple Health (Medicaid).

Such events include, but are not limited to:

• Losing health insurance, including an employer plan or individual health plan
• Losing Apple Health (Medicaid) because you no longer qualify
• Giving birth to or adopting a child
• Permanently moving to a new area where your current plan doesn't provide coverage
• Your employer not paying your COBRA premiums on time
• Your COBRA coverage ending or reaching the lifetime limit
• Your dependent turning age 26 and losing their coverage on your employer plan
• Getting married or entering into a domestic partnership
• Getting divorced or ending a domestic partnership
• Cancelling your Washington State Health Insurance Pool (WSHIP) coverage
• Your health plan no longer being offered for sale in Washington state

Most special enrollment periods are limited to 60 days from the qualifying event. Keep in mind that you won't qualify for special enrollment if you voluntarily cancel your health insurance or if your insurer cancels you because you didn't pay your premium.

If you don't qualify for special enrollment, here's some resources that may help you afford medical care.

Next year's open enrollment for individual and family coverage starts Nov. 1, 2016.

Who determines how much my totaled car is worth?

We hear from many consumers who are trying to resolve their auto total loss claims with their own insurer or another insurer. A total loss 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.

Read more about auto total loss on our website. Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Not sure if we can help you with an insurance problem? Ask us anyway

Recently, a Washington consumer posted a story on Facebook about her brother, who was on the waiting list for a heart transplant but was being put on hold because of “paperwork” issues with the insurance company. She asked her Facebook friends to file a complaint with the Insurance Commissioner, resulting in more than 40 complaints to our office.

One of our consumer advocates looked into the complaint and determined that the insurance provider was Apple Health, our state’s Medicaid program that is overseen by the Washington state Health Care Authority. In other words, we have no authority over the plan. But that didn’t deter our consumer advocate from trying to help.

First, we reached out to the Facebook user and asked her to let people know that they should contact the Health Care Authority with complaints about Apple Health. Then our consumer advocates reached out to the Health Care Authority to make sure this complaint was received and addressed as a high priority. The next day, we got an email from the concerned sister that said, “Thank you so much for your response and directing my complaint to the proper department. Today (my brother) got his insurance straightened out and is back at A1 status. Thanks again!”

We want people to be aware of this for two reasons: First, helping consumers access insurance is one of our missions, even if it’s not something we regulate. So even if you’re not sure if we can help you, reach out to us anyway. If we can’t help, chances are that we know someone who can. Second, social media is a powerful tool and is a way to quickly escalate a consumer problem. We have a robust social media presence, so don’t be afraid to reach out to us on Facebook or Twitter. We will make sure to get you to the right person.

Here’s how you can reach us:

• Talk to an insurance expert: http://bit.ly/consumerhelp or call 1-800-562-6900
• Connect with us on social media: http://bit.ly/OICsocial

Insurers should be current on emerging treatments for consumers

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.