Kamis, 28 Juni 2012

What was at stake in the ruling for Washington state

Earlier this month, we put out a report detailing what was at stake for Washington state -- down to the county level -- if the Affordable Care Act was thrown out by the Supreme Court.

The upshot was that more than 800,000 Washingtonians stand to get coverage through the Medicaid expansion OR to get subsidies to help them and their families pay for private insurance.

In addition, the report details the reforms, most of them largely unnoticed by the average person, that have already taken effect. Among these: Young adults can now stay on their parents' health coverage up to age 26, kids can't be denied insurance because they're sick, small businesses get tax rebates if they provide health coverage for workers, no caps on lifetime benefits, etc.

The most significant reforms will take place in 2014, including the state's new health care exchange, an online marketplace to shop for and compare insurance -- as well as a way for lower- and middle-income families to get substantial help paying for it.

The full report is at http://www.insurance.wa.gov/legislative/reports/Whats-at-stake.pdf.

Kreidler reaction to Supreme Court upholding health care reform law

OLYMPIA, Wash. – Insurance Commissioner Mike Kreidler expressed great relief with the U.S. Supreme Court’s decision upholding the Affordable Care Act and said Washington state is now well ahead of most states in reforming its health care system.

Many reforms are currently in place, but key benefits and programs take effect in 2014, including Washington’s new Health Exchange, federal subsidies to help 477,000 people afford health insurance, an expansion of Medicaid for 328,000 poor childless adults and the ban on insurance companies from denying people coverage if they’re sick.

“I’m very pleased the Supreme Court chose to uphold the Affordable Care Act,” said Kreidler. “We’ve been busy for two years now implementing the reforms and have made great progress, but there’s a lot left to do before 2014. With the court decision out of the way, we can continue our focus on where it should be – bringing relief to families struggling to find quality, affordable health insurance.”

The millions of Washington state consumers benefitting from the Affordable Care Act’s early reforms include:

  • More than 2.4 million people who no longer face lifetime caps on their health benefits.
  • More than 52,000 young adults up to age 26 who have stayed on their parents’ health plans.
  • More than 1.2 million people who now have coverage for preventive care with no co-pays or deductibles.
  • More than 60,000 people in Medicare who have saved hundreds on their prescription drugs.

Washington state also leveraged millions in federal funds available under the Affordable Care Act to create:

  • Public access to health insurance rate requests. 
  • A new marketplace in Washington state for health insurance in 2014 – called an exchange – where people can shop for health plans, compare their options and apply for subsidies.
  • A temporary health insurance program (PCIP-WA) for people with pre-existing health conditions.

“The Affordable Care Act is not perfect, but it moves us in the right direction and is the only meaningful reform that’s passed in decades,” said Kreidler. “The debate was clearly contentious, and I’m grateful to have it behind us. But, now it’s time to focus on the work ahead – more than a million uninsured people in our state are counting on us.”

Selasa, 26 Juni 2012

Cease and desist order issued against Lenovo

Insurance Commissioner Mike Kreidler has issued a cease-and-desist order against computer maker Lenovo, barring the company from continuing to sell illegal service contracts in Washington state.

From May 2008 to May 2012, Lenovo (United States) Inc. is believed to have sold $153,415 worth of service contracts in the state. The plans, which covered repair or replacement of damaged Lenovo products, can only be sold to Washington residents by a licensed insurer or a registered service contract provider. Lenovo is neither.

Kreidler also ordered the company to mail a copy of the cease-and-desist order to all its Washington customers within 10 days.

Nothing in the order prevents the company from fulfilling the terms of the service contracts or from issuing a refund, if requested.

The company’s unauthorized sale of service contracts was initially disclosed by Lenovo itself when it applied for registration as a service contract provider in April 2011. At that point, the company said, it had already sold 855 contracts for $90,630.

When Kreidler’s staff reviewing the application sought more information, the company failed to respond, and later withdrew its application (December 2011). Lenovo later said it had sold a total of 1,327 contracts worth $153,415 to Washingtonians (May 2012).

The company has a right to demand a hearing. The order takes effect immediately.

Sabtu, 23 Juni 2012

The Host with the Most

By Ivan Dashkov

As MGA was starting to become a reality, the owner, Fabian, reached out to the local volleyball community to start the process of securing rentals for the facility. One of the goals of MGA is to grow volleyball among all ages and skill levels. MGA is in a unique position with 12 courts because it has the ability to host several different volleyball activities among many age groups at the same time.  Now it was time to set up partnerships for rentals and events and secure other ways to generate revenue within the facility.

MGA set up a court rental rate, and for rental groups there is room for negotiation before signing a contract for an extended amount of time.  If you walk off the street and want to rent a court for one hour it is 75 dollars. However, with organizations that will be renting a lot of space and/or reserving court time for the long term, the will go down to 55-65 dollars per hour.

The first key partnership was with SMASH Volleyball. SMASH is the premier juniors’ volleyball club in New England and next season SMASH will base all of its teams out of MGA.  The club will be able to add more teams per age group as well as a boys program.  SMASH signed a contract to rent the facility for at least three years. Practices in the past for SMASH have been held in small gyms and MGA gives them a large place to practice as well as the ability to have multiple teams practice by themselves and then scrimmage each other on the same night..

MGA opened its doors by hosting the final two NERVA tournaments of the season. NERVA has done a wonderful job running juniors in New England and the facility will continue to host many NERVA tournaments. The first two tournaments each had over 500 people in attendance and that was with the use of only the first four courts. A gate fee was not applied at any of the tournament, however, in the future the facility plans to charge 5 dollars at the door. MGA does not plan on splitting the gate fee with the host club or organization unless an outside party rents MGA to have a gate fee event, and then a split would be negotiated.

MGA’s capacity to host large tournaments and its central location in New England makes it a prime place to host NERVA (New England Region Volleyball) events. Along with SMASH and NERVA, the Canton Cobras Volleyball Club will be based out of MGA and we are working with other juniors programs to have their programs in MGA.  MGA will also host several camps and clinics too.

Boston has a large population of adult volleyball players, so the next step was tapping into that demographic and potential client base. There are two organizations, Boston Ski and Sports Club and Social Boston Sports that provide high level social volleyball leagues in the area. MGA has partnered up with both of them to host leagues in the fall. The leagues will serve as trial runs for the future, and the hope is that these leagues will grow into partnerships that will last many years and be beneficial to both groups. MGA is also in talks with Yankee Volleyball. Yankee is the USAV sanctioned adult program in New England. It is our hope to bring Yankee into MGA and host large adult tournaments that New England rarely has.

Another successful idea was having open gyms. Every Monday night MGA has high school teams come in for captains’ practices and for the ability to scrimmage other high school teams in the offseason. Every Wednesday night is college night at MGA, where the local college kids and young adults come to play. Friday is family night and MGA has high school players as well as college kids playing on the court.

Another revenue source for MGA  is food and concessions.  There are two vending machines, and a concession stand that is used for larger events.  MGA is also working with local restaurants and eateries to help supply food for camps and tournaments.

There are plans for an apparel and equipment store, but for now the facility is using a room that is dedicated to selling merchandise.  MGA will wait until late summer/early fall to complete the store, just in time for larger events to begin.  It has been an exciting journey to piece together the various revenue sources for MGA Sports. The demand and anticipation for this facility in Boston has been long overdue, so many parties are anxious to get events on the calendar.  MGA has high hopes for the future of this facility and the impact it will have on the local volleyball community, and slowly but surely the pieces were falling into place.

Kamis, 21 Juni 2012

Theft charges for medical worker who submitted $4 million in bogus bills, sometimes claiming to be a doc

We're going to post a news release soon about this case:

A medical worker submitted at least $4.1 million in bogus bills to insurers, sometimes while falsely claiming to be a doctor or physician’s assistant, has pleaded guilty to theft.

Kenneth R. Welling, 45, of Lake Forest Park, pleaded guilty Thursday in King County Superior Court. The charges -- all of which are felonies -- include one count of first-degree theft and six counts of second-degree theft.

“This was a pretty audacious scam,” said state Insurance Commissioner Mike Kreidler. “We were tipped off to it when a patient contacted us, saying that Welling billed her insurer $89,000 for six surgeries that never happened.”

Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither.

Kreidler’s investigators also found numerous instances in which Welling billed for surgeries that never happened. Sometimes he would include post-operative reports, listing himself as the surgeon.

No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.

“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.

In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.

From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.

“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”

The investigation also showed that some patients were complaining to their insurers.

“I am angry!” one woman wrote to her insurance company in 2011. “Here is yet another fraudulent claim. Can’t you people help me to stop this? I never had surgery on Aug. 27, 2009. I never met or had anything to do with Ken Welling.”

A sentencing date is expected to be scheduled soon.

Rabu, 20 Juni 2012

Kreidler statement on Regence's proposed 14.7 percent rate hike

Regence BlueShield, one of Washington state's largest health insurers, is proposing an average 14.7 percent hike in premiums for its customers who buy coverage on their own.

Even with that increase, the company says it would also face a loss of $4.5 million from its surplus, which currently exceeds $1 billion.

Here's state Insurance Commissioner Mike Kreidler's statement on the proposal:

“We’ve just received this request. It will undergo a rigorous review by our actuaries.

“Regence contends that even with this increase, it would lose $4.5 million from the company’s surplus. To put that in perspective, that’s less than half of 1 percent of the company’s $1 billion surplus.

“In fact, Regence could continue to lose $4.5 million annually for the next 220 years and it would still have a surplus.

“A similar request by a sister company, Regence BlueCross BlueShield of Oregon, sought a 6.4 percent increase, starting August 1, 2012. But after our review and objections, it withdrew the request today. Any future rate request will face the same thorough scrutiny.”

Jumat, 15 Juni 2012

The Renovation

By Ivan Dashkov

After Fabian (MGA Sports Owner) and his investors picked the perfect location to house the 12 court facility, the process of alternating the former warehouse into a volleyball gym began. Before any new lights were hung or any sport court laid down, walls had to be torn down. The warehouse was originally used to ship beverages and other products. The space that is now home to our lime green, purple, and future sand court used to have a walk in freezer. Initially there was an idea to keep the walk in freezer and turn it into a sand volleyball area. It quickly became apparent that the freezer had to go. Another major change that was made was tearing down a wall that split up the main four courts from the back eight. This wall was supposed to stay up and until very late into the process. However, the building manager offered to take it down and Fabian jumped on the opportunity that created a more open feel to the complex.

Besides those two major changes, a lot of smaller construction had to be done as well. One of the most time consuming was the remodeling of the front office area as well as the far bathrooms. The front office was expanded to include not only a business office but also a room for referees, a pro shop, a large education room, and locker rooms. The education room will be primarily used to review tape and for coaches’ education. It was also positively received by the SMASH community as an area where parents and siblings can do work while their daughter or sister is playing. The new bathrooms in the locker room and the construction of the far bathrooms took a long time because they required the installation of new plumbing as well as fixtures. Fabian planned ahead by having the ceilings of both the office area and the far bathrooms reinforced. While there is nothing on top of them yet, it will allow them in the future to have a second floor that can be used for spectator seating, storage, more offices, etc.

Fabian spared no expense when he picked the materials that were used for the courts. He purchased top of the line sport court that features Shocktower technology from Snap Sports. This is the most advanced sport court available on the market. By using this as the flooring he did not only insure the safety of everyone who will play at MGA, he also made a smart business decision. If he purchased an older version of sport court it would have become outdated quickly and would have needed to be replaced quickly. Fabian also purchased lights that would be non-intrusive during play. It is important to have lights picked out early in the construction process. The flooring had to wait until the lighting was installed.

Another addition that was installed is an advanced sound system. The sound system has been a welcomed addition as it makes the facility more fun to practice in and allows for an intercom system that Fabian can broadcast through. The net systems used in the facility are from Gared Sports. Fabian traveled to their offices and looked through various models before deciding on one. He developed a strong relationship with Gared Sports. Fabian had a few alterations he wanted to be done to the net systems he picked and Gared was very accommodating.

By creating such a large and high quality facility, MGA has created a place where Massachusetts and New England volleyball can grow. The added space will allow for NERVA Juniors to grow as it will offer a great location for tournaments and for practices for teams in the region. SMASH Volleyball is already committed to expanding its offerings by offering more teams for girls juniors and adding boys juniors as well. MGA wants to foster this kind of growth throughout New England volleyball because it has the court space and quality to allow for the expansion of offerings at any level. 

Rabu, 13 Juni 2012

Insurance tips: Credit scores and insurance scores

Many insurers use a credit-based "insurance score" as a factor -- a major factor, often -- in setting your rates. It's a quick way of quoting you a price, and insurers maintain that there's a correlation between these credit-based scores and a person's claims history.

Washington state limits how insurers can use these scores, and Commissioner Kreidler has repeatedly pushed for legislation to ban their use completely.

In Washington, insurers cannot hold the following things against you:
  • The number of credit inquiries
  • Collection accounts identified as medical bills
  • A loan if it's the initial purchase or finance of a vehicle or home.
In Washington, insurers must also tell you if you didn't get the best rate due to your score. If this happens, you're entitled to a free copy of your credit report from the credit agency that your insurer used.

What goes into an insurance score? Here's the breakdown of a score from FICO, one of the biggest companies generating these scores for insurers:

• Payment History (40%) – How well you have made payments on your outstanding debt in the past

• Outstanding Debt (30%) – How much debt you currently have

• Credit History Length (15%) – How long you have had a line of credit

• Pursuit of New Credit (10%) – If you have applied for new lines of credit recently

• Credit Mix (5%) – The types of credit you have (credit card, mortgage, auto loans, etc.)

How can you improve your score? The same way you'd improve your credit score: make payments (bills, taxes, fines, etc.) on time. Keep credit card balances as low as possible. Think carefully before opening new lines of credit, such as a department store charge card, just to get a discount.
You can check your credit reports from the three nationwide consumer credit reporting companies annually at http://www.annualcreditreport.com/. If you find errors, contact the credit reporting company to have them corrected.

Senin, 11 Juni 2012

Insurance and vintage or antique cars

Q: I'm rebuilding my antique car and my grandfather's one-seater vintage biplane in my garage. Will my homeowners policy cover all the parts if they are stolen?

A: Probably not. Most homeowners policies exclude autos, aircraft, other motorized vehicles and their parts. You might have coverage for, say, a riding lawn mower or golf cart, but you'd be wise to talk to your agent and insurer about separate coverage that may be available for the parts during the rebuild process and after completion. Most antique cars and planes can be covered on specialized policies designed for their generally limited and unique use.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Jumat, 08 Juni 2012

Coming this fall: Agents and brokers in WA can submit fingerprints electronically

In Washington, as in most states, we require insurance agents and brokers to submit their fingerprints for the required background check.

For years, this has been done on paper cards, on which a worker rolls the applicant's inked fingers. It's messy, but more importantly, it's difficult to get good, usable prints. In fact, there's a 30 percent rejection rate by the State Patrol, meaning that the applicant has to go through the whole process again. We know it can be a pain, but we haven't had a good alternative.

So, good news: Starting late this summer or early fall, we will begin accepting electronically submitted fingerprints. We strongly encourage our resident applicants to use the service.


For one thing, the rejection rate is much lower. Instead of 30 percent, it's less than 3 percent.

It will also cost less. It now costs $42.50 to submit a paper fingerprint card. It will cost $32.50 to do it electronically.

It takes less time. In fact, in some cases, it could mean getting your license issued weeks earlier than with a paper card.

And there's probably a location close to you. More than 30 locations in Washington state can provide the fingerprinting service. Pearson Vue exam centers offer the service when applicants take the insurance exam, and the company also has a third-party vendor, Morpho Trust, that offers fingerprinting at several additional locations. You can find links to both on our new web page about electronic fingerprinting for insurance licensees.

Lastly, a question I know we'll get: Are electronic fingerprints required? No, not at this point. But we intend to require them starting during the first half of 2013.

Kamis, 07 Juni 2012

Open letter from Commissioner Kreidler to Premera and LifeWise policyholders

Our office has denied requests from Premera Blue Cross to strip some of the company's health plans of vital prescription drug coverage.

Premera filed a request with our office in late April, seeking approval to remove all prescription drug coverage from its small employer plans. These are plans sold to employers with 1-50 employees. Premera subsidiary Lifewise filed a request to remove drugs from all of its catastrophic (meaning high-deductible) plans.

Commissioner Kreidler disapproved those requests. Here's an open letter from the commissioner to Premera and Lifewise policyholders. From the letter:

Let me be clear: Contrary to what Premera has implied, your health plan can keep generic drug coverage and even require you to use a generic drug first. Nothing in my recent decision restricts your health plan from covering generic drugs.But if you get sick and a generic drug doesn’t exist for your condition or doesn’t work for you, your health insurer must let you try a brand-name drug that could work.

I understand that generic drugs may work for many people most of the time, but it’s my job to protect all insurance consumers. There are some diseases for which generic drugs may not work, such as certain cancers and mental illnesses, diabetes, MS, certain types of arthritis, and AIDS.

Legally, if a plan has prescription drug coverage it cannot restrict someone’s access to a prescription drug that could be vital to a medical condition that’s otherwise covered by the plan and for which they’ve paid a premium.

Rabu, 06 Juni 2012

New insurance bills take effect tomorrow

Four new insurance-related bills take effect tomorrow. None were insurance commissioner request legislation, but they will impact consumers starting June 7.

Whether you'd like to share your car or get evacuated home from a trip, there's something for everyone. Want to know more? Here's the complete list:

Usage-based insurance

Car sharing

Air rescue

PEBB ombudsman for retired state employees

Senin, 04 Juni 2012

Insurance and sleepovers

Q: My daughter's having a friend over for a sleepover. If the friend trips and falls or something, would my homeowners policy cover her medical bills?

A: Generally yes, since most modern homeowners policies have what's known as "guest medical" coverage. This is designed to pay the medical bills -- up to a specified dollar limit per accident -- for accidental injury to guests. But it doesn't cover you or other resident family members.

The coverage is a no-fault type of coverage that is designed to apply to accidents with no determination of fault or negligence on your part. Your insurer will still do an investigation to gather the facts of the accident.

Note: This is one of a series of common -- or in some cases, particularly unusual -- questions received by our consumer advocacy staff, who answer questions from consumers.
Got a question or insurance problem of your own? If you live in Washington, feel free to give us a call, toll-free at 1-800-562-6900. We'll do our best to help. (And if you live in another state or territory, here's a handy map that lists the contact info for your local insurance regulatory office.)

Jumat, 01 Juni 2012

Washington state insurance markets: Our annual report

Each year, we issue an annual report summarizing the insurance markets in Washington state, selected financial statement data, authorized insurers by line of business, top companies, top groups, company changes, etc.

Get 'em before they're sold out. (That's a joke. They're online only, and we have no shortage of pixels.)

It Begins!

By Ivan Dashkov

Fabian Ardila is the man behind MGA Sports. Opening MGA Sports is a dream come true for the facility’s owner and coach for SMASH VolleyballHis unending passion for volleyball, and his professional drive and vision have helped him navigate through the obstacles and setbacks of creating a volleyball facility. The original idea was to create a sports center composed of several sports for juniors. In addition to volleyball, it included soccer and basketball as the three main pillars of the complex.

After doing extensive research it became apparent to Fabian that the need for a volleyball specific facility was more of a necessity for the region.  He wanted to start MGA with one goal: to grow the sport of volleyball in New England.  Currently, when compared to the rest of the country, the level of volleyball in New England is considered weak. The goal of MGA Sports and SMASH Volleyball is to create an environment in New England that can foster development of juniors. His vision is to reach and teach young athletes about the dynamic, competitive, robust sport of volleyball in a fun, safe and nurturing environment.

After forming the idea to create a complex focused on volleyball, the next task was to find a location. After researching the success of similar facilities, MGA Sports found that the most successful facilities were the most accessible ones. The goal was to find a facility that was easily accessible to everyone in the greater Boston area in addition to New England. Originally, the idea was to build a new complex from the ground up. However, there wasn't any land available that was suitable for the facility and easily accessible. Fabian then decided to find a warehouse that he could renovate. After a long search lasting several months, he finally found a perfect location in Norwood, MA easily accessible from Route 128 and Interstate 95. See Map.

Another huge hurdle was finding investors for a long-term lease. In this economy, a lot of investors were not interested in the long term. After a few angel investors fell through, Fabian turned to his friends and family, who believed in him and the project. Fabian put his life savings into his dream in addition to the money invested by other family members and friends. Once the bank saw the level of investment from Fabian, they felt confident in loaning the rest of the money for the project. A 20-year lease was signed, with the bank paying for 80% of all the equipment, leaving the remaining 20% on Fabian and MGA Sports. 

Fabian offers advice to anyone interested in building a similar facility saying, “Make sure you have a patient and persevering personality first, then make a sensible budget. Finally, triple your budget and you should be OK.”  After 3 months, the paperwork was complete and the facility was in the hands of Fabian and MGA Sports.  Now the excitement of renovating the facility was about to begin.

Fabian wanted to be able to grow volleyball by offering high level camps, clinics, and other opportunities for juniors and adults.  The plan was to have a 12 court facility in order to be able to offer a variety of programs.  Also, by having a 12-court facility, SMASH Volleyball could become a bigger club offering more opportunities for junior girls and begin to offer boys volleyball as well. 

Learn how the renovation process began and continued during the past few months in the next post.  

Do you have questions for Fabian or Ivan?  Make sure to post them on the blog!

About the Author: Ivan Dashkov is the Director of Marketing and Digital Media at MGA Sports. He has been involved in volleyball for the past decade. He is currently a coach at SMASH volleyball. He graduated from Ithaca College in May of 2011 and was awarded the Ithaca College Professional Excellence Award in Sport Management and Media. At Ithaca, He served as an assistant coach to the Division III volleyball team. He played college club volleyball and received All-Conference honors his junior year. Ivan grew up in Massachusetts and was originally born in Kazakhstan.