State of Washington Directs Insurance Companies on Regulations Relating to Patient Protection and Affordable Care Act Consumer Assistance

Pursuant to provisions of the Patient Protection and Affordable Care Act (“PPACA”), which requires insurers and health plans to provide information about the appeals process to consumers, as well as make consumers aware of their state’s health insurance consumer assistance or ombudsman programs in denial notices, Washington State Office of the Insurance Commissioner advised that the U.S. Department of Health and Human Services has designated the Washington State Office of the Insurance Commissioner’s Consumer Protection Division as the current health insurance consumer assistance office or ombudsman.

In addition to the PPACA requirements, effective July 29, 2011, new State of Washington emergency regulations require health insurers to “direct appellants to the Office of the Insurance Commissioner’s Consumer Protection Division for assistance with questions and complaints” WAC 284-43-525(4)(c) at http://www.insurance.wa.gov/laws_regs/documents/2011-14103E.pdf.

For details on how insurers should handle consumer notifications, insurers are directed to review R 2011-14 Grievance and Appeals Rules at http://www.insurance.wa.gov/laws_regs/documents/2011-14103E.pdf.

Consumers who need assistance should be directed to the Insurance Consumer Hotline at 1-800-562-6900.  A guide to how to appeal a health care insurance decision can be accessed at:  http://www.insurance.wa.gov/consumers/health/appeal/Table-of-Contents.shtml

A letter on the issue from Washington Insurance Department Consumer Advocacy Department Manager Mary Childers is attached for review.

Should you have any questions or comments, please contact Colodny Fass.