Direct practices lose 35 percent of enrollees, raise fees 23 percent

Each year, the OIC reports to the Legislature on the status of direct health care practices in Washington. A direct health care practice is an arrangement where a health care provider charges a patient a set monthly fee for primary health care services. The provider doesn’t bill the patient’s insurance for the services and only provides certain medical services in the office.

The December 2014 report contains data from July 1, 2012 through June 30, 2014, which is two fiscal years’ worth of information.

Some highlights from the report:

• As of June 30, 2014 there were approximately 8,658 direct-practice patients in Washington at 29 practices around the state. Patient participation decreased by 35 percent from fiscal year 2013. Four new practices opened in Seattle, Camas and Centralia. Three practices closed in Spokane and Lakewood.
• Monthly fees at direct practices ranged from $25 to more than $200. The most expensive was $910 per month. The average monthly fee weighted by the number of patients was $150.78, a 23 percent increase from fiscal year 2013.
• The OIC received no consumer complaints regarding direct patient practices in fiscal year 2014.

The Affordable Care Act now requires health insurance plans to cover 10 essential health benefits, which include preventive services and chronic disease management. It also puts a cap on deductibles that consumers pay each year and direct practice fees do not count toward that yearly maximum. In addition, Washington expanded its Apple Health (Medicaid) program and the state’s individual health insurance market grew 30 percent in fiscal year 2014 to more than 327,000 people.

View the full report to the Legislature.

What should I know about travel insurance?

If you are getting ready to travel for the holidays, here are some things to consider about travel insurance before you purchase it.

Many travel companies—airlines, cruise lines, resorts—offer travel insurance that will refund most or all of the cost of the trip in certain circumstances. Policies typically cover things like trip cancelations due to illness, civil unrest, job loss, or the transportation carrier going out of business. They’ll also pay for fees incurred by missed connections and delays; baggage damage or loss; medical expenses incurred by an injury or illness while traveling; emergency evacuation; car rental damage; and accidental death.

Before you decide whether to purchase travel insurance, you should consider:

• What your medical insurance covers when you travel.
• What your homeowner or renter insurance covers in the event of lost or stolen belongings.
• What your life insurance policy covers in the event of accidental death while traveling.
• The cancelation policy is for the travel insurance.
• Read the policy's fine print. Some don't cover certain activities such as hang-gliding, bungee jumping or other activities. Some also exclude certain pre-existing conditions from the medical coverage they offer.
• You should also make sure the travel insurance company is licensed to sell insurance in Washington.

Read more about travel insurance on our website.

Questions? You can contact our consumer advocates online or at 1-800-562-6900.

Some homeowner policies offer percentage deductibles

When you are considering homeowner insurance, it’s good to be aware of what type of deductible you have. Some insurance companies charge deductibles that are a percentage of the home’s value, rather than a flat dollar amount. For example, if your deductible is 0.5 percent and your home’s value is $500,000, your deductible would be $2,500.

Some people would prefer to pay a higher deductible and get a lower monthly premium. It’s important to do the math and find out what that half-percent will cost you. Keep in mind, your home’s value is likely to increase over time, which means your deductible will, too.

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

Been in an auto accident? Beware of this scam

KING 5 news reported yesterday that some accident victims are being scammed into getting unnecessary chiropractic treatment to drum up payments from insurance companies. Consumers who experience this -- or any other type of insurance scam -- should report it to our consumer advocates at 1-800-562-6900 or online.

According to KING 5, the scammers use Washington State Patrol’s collision reports to find people who've been in auto accidents. One family reported they were led to believe the insurance company wanted them to be seen and gave them a time limit for the visit.

"They said the claim was going to close immediately. They said we need to come in if we want to have any future claims," the victim told KING 5. 

If you are involved in an accident, the auto insurance company will not require you to see a doctor. It is up to you to seek medical treatment at your discretion. However, if you claim you have medical problems related to an accident, the insurance company may request verification from a medical professional. Consumers should always contact their insurance company’s claim representative or their insurance agent or broker when they have questions about a claim.  

In addition to misleading consumers, tricking consumers into getting unnecessary treatment can drive up insurance rates. Insurance companies base their rates in part on the claims they paid in previous years and unnecessary claims get factored into future rate increases.

Read more about insurance fraud and scams.

Can OIC recommend insurance agents to consumers?

Consumers call our hotline daily to ask us questions about insurance. Sometimes, consumers ask us to refer them to insurance sales agents who might be able to sell them the type of coverage they are looking for.

While we do regulate the insurance industry, we do not refer consumers to specific agents or brokers. However, we encourage consumers to check the licensing status of agents, brokers or companies on our website. Consumers can also call our hotline and ask one of our consumer advocates to look up that information on their behalf.

Read more about your insurance on our website.

Questions? Contact our consumer advocates online or by calling 1-800-562-6900.

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