Category: News

Options when a health insurance claim is denied

The Orcas Island Health Care District and Orcas Island Fire and Rescue continue to work together, along with other County-wide leaders, to resolve ongoing concerns related to Kaiser Permanente’s coverage for emergency medical air transport.

As a consumer, if you experience a denial from your insurance company for any covered service you can contact the Office of the Insurance Commissioner for WA State (OIC) for assistance.

The Insurance Commissioner’s office answers hundreds of insurance questions every day, and you can easily file a complaint against your insurance company on their website. You can also call the toll-free Insurance Consumer Hotline at 800-562-6900.

What the OIC can do:

  • Send your complaint to the insurance company and require them to provide an explanation for their actions.
  • Send your complaint to the Washington Healthplanfinder and ask them to resolve your concerns.
  • Review the company’s response to make sure they followed Washington state laws and your policy.
  • Tell the company to fix the problem if they didn’t follow the laws or your policy.
  • Try to find patterns of problems that may need further reviewing.
  • Try to help fix your insurance problem or help you and the company communicate with one another.
  • Help you understand your insurance policy.
  • Recommend places you can go for help if we don’t have the legal right to resolve your complaint.

What the OIC can’t do:

  • Act as your lawyer, give you legal advice or be your claims adjuster.
  • Make medical judgments or determine if further treatment is necessary.
  • Make liability decisions or determine who is at fault.
  • Establish the facts surrounding a claim (for example: who is being truthful when there are conflicting reports of the situation).
  • Determine the cause of loss, value of a claim, the amount owed to you, or act as your adjuster.
  • Address issues we can’t legally enforce.
  • Require the Washington Healthplanfinder to comply with state insurance laws as it’s not an insurance company regulated by our office.
  • Tell a company to pay a claim, refund a premium, or reinstate or issue a policy (if they followed the law and your policy).

Update on Kaiser Permanente Air Transport

By now, most islanders have heard or read about a number of denials from Kaiser Permanente associated with medical air transport by either Airlift Northwest or Island Air. The situation has impacted residents throughout the County and is part of what’s emerging as a national trend to more closely monitor the necessity of emergency air transport. As is the case with many issues related to the delivery of health care, we are very different here in San Juan County and emergency air transport is an essential component of  care delivery for islanders.

The OIHCD Superintendent learned about this emerging situation soon after the start of the year, and reached out to Kaiser to better understand what was happening. Over the past two months, Superintendent Presson has been working very closely with Orcas Island Fire & Rescue (OIFR) Chief Williams, Orcas Island County Council Member Rick Hughes, the San Juan County EMS Medical Director, and various other leaders throughout the County. In addition, Superintendent Presson has been working with Mark Tompkins, Director of SJC Department of Health & Community Services and the Board of Health, as the Board became very concerned with the implications on public health should this trend continue. There was a very informative discussion at the February 20th Board of Health meeting, which included representatives from both Airlift Northwest and Island Air. Click on the Board of Health video link to see live and recorded meetings.

At this point, the physician leadership from the County and Kaiser Permanente are scheduled to meet in an effort to resolve the situation. This will include a review of the processes in place that ensure every medical air transport in the County is at the direction of an emergency medical professional. The OIHCD Superintendent remains actively involved and will continue to provide updates.

For anyone who has experienced an air transport denial, both air operators have customer service representatives to assist you. Please contact either Airlift Northwest at 866-245-4373, or Island Air at 360-378-2376. In addition, islanders are welcome to contact OIFR for assistance.

 

Board Meeting Materials

The Agenda and Meeting Documents for the October 2, 2018 Regular Board meeting are now posted. Due to the anticipated need for additional time to get through all of the financials, the meeting will start an hour earlier at 3 pm.

Meeting Notice

Please be advised that the Regular Meeting of the Board of Commissioners scheduled for Tuesday, September 25th, is cancelled.

New District Office

The OIHCD now has an official District Office. We are located on the second floor of the Windermere building at 18 Haven Road, on the corner of Main and Haven. Please visit the Calendar Tab to see office hours for Superintendent Presson. You can also email her to set up a time to meet.

Notice

The Agenda for the September 11th Regular Board meeting has been posted. The complete Board Packet will be posted on the Meeting Documents page at the end of the day on Monday.

Notice

Please join the Board of Commissioners this Saturday, September 8th, for the first of two Town Hall style meetings. The meeting will be held from 3 – 5 pm at the Orcas Island Fire & Rescue Eastsound Fire Hall. The Board wants to hear from YOU so bring your questions and thoughts about health care services on Orcas Island. The Board will also provide highlights of their activities since May and the focus of various work groups. The second Town Hall meeting will be held on Thursday, September 20th, from 6 – 8 pm.

Notice

The Agenda and materials for the September 4th Regular Board meeting have been posted in the Meeting Documents tab.

Notice

There will be a Special Meeting  of the OIHCD held on Tuesday, September 4th, from 2:30 – 4:00 pm. The purpose of the meeting is for the technology provider, NW Technology, to conduct a computer training for the Board. The meeting will be held at the regular location, OIFR Eastsound Fire Hall.

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