Most colonoscopies should be covered 100% by your insurance

The Affordable Care Act (ACA) requires that insurance companies cover 100 percent of the cost of preventive colonoscopies for adults older than age 50. Of course you’ll need to see a provider who is part of your plan’s provider network.

However, despite this new reform, we do hear consumers who’ve had a routine preventive colonoscopy only to have their insurer process their claim as “cost-shared diagnostic care,” which is subject to their annual deductible and coinsurance.

We also sometimes hear from consumers who receive a substantial surgical bill when a polyp is discovered and removed during a preventive colonoscopy. The Affordable Care Act and other federal guidelines protect consumers from extra charges for polyp removal during a preventive colonoscopy. If you receive a bill for polyp removal, you should file a complaint with us and we’ll help you get those charges reversed.

If you are diagnosed with colon cancer, any previous related symptoms may result in your provider processing the cancer screening as diagnostic and not preventive. In that case, your treatment would not be covered as preventive care and you’ll likely have additional costs. If you have any questions, check with your doctor.

Be aware that if a procedure or treatment is not a recommended preventive service, it may be subject to your plan’s deductible and cost-sharing. Also, if a medical recommendation or guideline regarding a preventive service does not specify the frequency, method, treatment, or setting for that service, your insurer may limit your coverage.
Here are some important tips to remember:

• If you have any questions, first talk to your doctor or medical provider and your insurance company. 
• Read more about which health benefits are required under the ACA.
• If you receive a bill from your insurance company that you disagree with, request an appeal.
• In addition, file a complaint with us.

Protect yourself from Medicare fraud

The Insurance Commissioner’s Statewide Health Insurance Benefits Advisors (SHIBA) program is Washington state’s Senior Medicare Patrol (SMP). A federally funded and volunteer-based program, SHIBA/SMP volunteers provide education on how to prevent, detect and report Medicare fraud.

Medicare is the national health care plan for all U.S. citizens age 65 and older. It also covers people younger than age 65 who receive Social Security Disability Income and people who are diagnosed with certain medical conditions.

In Washington state, SHIBA/SMP volunteers help protect seniors and fight health care fraud, leaving more money in the system for everyone. Our state’s volunteers educate beneficiaries on how to avoid becoming victims of health care fraud, and how to report abuse or fraud, related to their Medicare benefits.

We all pay a price for Medicare fraud, waste and abuse, which contributes significantly to rising health care costs. There are three things you can do to help fight Medicare fraud:

1. Know your rights. As a person with Medicare, you have certain rights and protections designed to help protect you and make sure you get the health care services the law says you can get.
2. Protect your identity. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes. Keep this personal information safe:
• Your name.
• Your Social Security Number (SSN).
• Your Medicare number (or your membership card if you’re in a Medicare Advantage or other Medicare health plan).
• Your credit card and bank account numbers.
3. Get involved with other seniors with the Senior Medicare Patrol (SMP). The SMP educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse.

You can find more Medicare fraud tips on our website. If you suspect Medicare fraud or have questions about your bill:

• Call OIC’s Statewide Health Benefits Insurance Advisors (SHIBA) at 1-800-562-6900 or email us at shibahelpline@oic.wa.gov.
• Contact your local SHIBA office.

Have a quick question? Try our new live chat

This week is National Consumer Protection Week and the OIC is one of the many government agencies that helps protect consumers from financial harm.

A huge part of the work we do is helping and educating consumers about all things insurance, from answering questions to looking into complaints against insurance companies, providing help with filing appeals for claim and coverage denials and everything in between.

We recently launched a live chat feature to help consumers get answers to their quick questions about insurance and their rights. Consumers can chat with one of our consumer advocates Monday through Friday from 10 a.m. to noon and from 2 p.m. to 4 p.m. If your question needs more attention, we will direct you to the right place to get the help you need.

Consumers can reach us:

• By phone at 1-800-562-6900
• Online
• Through our social media channels 
• File a complaint against an insurance company or professional. Our complaint system is optimized for mobile devices.  

Helping Washington consumers is our mission

This week is National Consumer Protection Week and the OIC is one of the many government agencies that helps protect consumers from financial harm.

Consumer protection is part of our mission, which is reflected in the way we do business. Our consumer advocates can help:

• Answer questions about home, auto, health, life, annuities, business and other insurance. 
• Understand your insurance rights, including your health insurance appeal rights and the process. 
• Look into complaints against insurance companies. 
• Provide you with information about your insurance options. 
• Verify if an agent, agency, or company is authorized to sell insurance in Washington state. 

In 2015, our consumer advocates fielded 6,130 consumer complaints and helped recover more than $9.1 million in insurance billings, refunds and other claims-related issues for Washington citizens. Read more about the ways we helped consumers in 2015.

We share information of interest to insurance consumers on this blog and through our social media channels. Many of our blog posts are generated by questions our consumer advocates receive from Washington citizens.

More resources for consumers:

• Reach us by phone at 1-800-562-6900 or online.
• File a complaint against an insurance company or agent. 
• Read more about consumer advocacy at OIC.
• Read more about your insurance, including home, life, auto, health, annuities and business.