More MS news articles for Aug 2001

Wielding power of persuasion

http://www.journalstar.com/nebraska?story_id=4084&date=20010820&past=

Tuesday, Aug. 21, 2001
BY NANCY HICKS Lincoln Journal Star

Chris Curtis calls it the Hall of Fame.

It's a bulletin board covered with thumb-tacked thank-you notes from grateful taxpayers for help in battling insurance companies.

There are even a few lids from candy boxes hanging from the wall, but no evidence of the bag of Krispy Kremes FedEx'd from a very satisfied Omaha caller.

The messages to the Consumer Affairs Division of the state Department of Insurance have a similar theme: gratitude laced with frustration.

"Perhaps this wake-up call to them will help save someone after me with similar unnecessary unpleasantness. Although with this outfit, I doubt it."

"If it weren't for you, I don't think those SOBs would have paid."

Consumer Affairs, which Curtis heads, can't answer every question or solve every problem, but it can be a godsend to people.

Like the man who spent a month in the hospital after being diagnosed with multiple sclerosis. His insurance company refused to pay for the hospital stay, saying the MS was a pre-existing condition.

The man had injured his foot in previous employment, and the insurance company said that injury could be considered a precursor to MS.

But the state Insurance Department asked the company to take a second look, and an independent reviewer said the foot problem should not be considered a precursor condition.

In the end, the company paid the more than $20,000 bill, Curtis said.

The Consumer Affairs Division answers 1,380 phone calls a month from the public -- questions and complaints.

The division includes seven investigators and a clerk who answers most calls and is an encyclopedia of basic insurance information, Curtis said.

Most consumers have questions about their property and casualty insurance or health insurance, not life insurance, because most people who buy life insurance are pretty sophisticated, she said.

Questions and complaints usually arise when consumers are having trouble collecting what they think is rightfully theirs.

So the clerk, Lana Garrison, gets bombarded with calls a month or two after every hail storm or wind storm.

In fact, the division's biggest month for telephone calls was July, when 1,510 people called, many from the Omaha area and western Nebraska who had damage from April and May storms.

The agency can't order a company to change a decision. Staff members have only the powers of persuasion and the ability, because of experience, to look for the right information.

Recently, the big health insurance question has been skyrocketing premiums, 12 percent or more, Curtis said.

The department can't change the ingredients that go into rate increases - rising medical costs and more claims.

"We're seeing some tremendous inflation in medical costs."

If companies don't make money, they are going to go bankrupt or pull out of this insurance market. Neither is a viable option, she said.

But the staff can check to see that a premium was calculated correctly and that the company filed its new rates with the state, she said.

On other issues, they can sometimes change a company decision. One car insurance company purchased a new seeing eye dog for a woman after a car hit her and her dog. The woman was injured and the dog was so traumatized he was no longer useful as a guide dog.

The company originally said it was not responsible for injuries to the dog, Curtis said.

"We can be persuasive verbally," she said.

Curtis also monitors the complaints to look for trends - a company that may habitually take a very long time to pay claims, for example.

Trends are helpful in spotting bad companies, illegal practices or something that needs legislative correction.

That's why Curtis suggests making a complaint even if you don't expect results.

For example, numerous complaints several years ago about denial of coverage for temporolmandibular joint syndrome, often called TMJ, led to changes in state law so insurance plans were more likely to cover the jaw disorder. Today, group plans have to offer the coverage as an option to an employer.

With multiple complaints the department also has a better chance of proving a company is violating state law, she said.

Doing something once - offering a settlement that is less than the policy allows or not responding in a timely fashion - is not a violation of state law. But if the state can show that behavior occurs with such frequency it is a general business practice, the division has a potential case.

Health insurance questions, beyond rising premiums, fall in two general areas:

Insurers deny a claim because it wasn't medically necessary. Often those issues relate to the number of days a person is in the hospital. The best way to convince a company that something is medically necessary is to get a physician on board.

Someone is dying and the insurance company says the treatment is experimental.

"These are the heart-breaking ones," Curtis said. But the agency occasionally has been able to change a decision.

Reach Nancy Hicks at nhicks@journalstar.com or 473-7250.
 

Copyright © 2001, Lincoln Journal Star