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The employees of the Oklahoma Insurance Department are here to help Oklahoma’s consumers with their insurance questions and problems. By law all case information is confidential for every consumer who files a Request for Assistance (RFA) with the Oklahoma Insurance Department. However, the following consumers have agreed to share their stories with the public to illustrate the work OID performs on behalf of Oklahomans.
OID HELPS RESTORE ENID MAN’S LONG-TERM CARE POLICY
William Brant Sr. had a long-term care policy for ten years. But when he finally needed to use it, it wasn’t there. The policy had somehow lapsed. His family turned to the Oklahoma Insurance Department and Commissioner John D. Doak for help.
The oversight happened just a few months after the death of his wife. William and Beverly Brant had been married for more than 60 years. William, despondent and preoccupied over the loss of his wife, mistook the policy lapse notice for another document. Then, the 85-year-old left the state to spend time with family. The policy premium was never paid.
No one realized the mistake until William took a bad fall in December. When his son Bill checked into his father’s long-term care policy, he was told it had lapsed. Bill called his father’s insurance company and was informed that the policy hadn’t been paid since April. He was also told that it was too late to reinstate the policy because the 5-month reinstatement window had passed.
“I don’t understand how a person can have a policy for ten years then the insurance company just cancels somebody. You’ve got to do more than write two form letters before terminating the policy,” Bill said.
After getting nowhere with the insurance company, Bill began writing letters. He sent complaints to Gov. Mary Fallin, state lawmakers, even the newspaper in his father’s hometown of Enid. When his plea reached the Oklahoma Insurance Department, Lydia Shirley with the Consumer Assistance Division quickly went to work.
“Lydia Shirley was compassionate and understanding. It was really nice to talk with someone who wanted to help,” Bill said. With just a few phone calls and letters, William Brant’s long-term care policy was reinstated. After Bill paid the premiums for 2011 and 2012, his father’s coverage was restored in full, all the way back to April 2011.
“When something like this happens, that’s when the value of the Oklahoma Insurance Department comes in. They put a human face to the problem. It also shows the power of the department to protect senior citizens,” Bill said.
He wants others to know that when it comes to insurance complaints, they aren’t alone.
“Oklahomans need to come to the Oklahoma Insurance Department with their problems. They have the power to work with the insurance companies and help you.”
Protecting Oklahomans is a central theme in Commissioner Doak’s administration. His office receives more than 30,000 assistance calls a year.
“My focus is for consumer needs to be met, especially the elderly. Lydia Shirley and her team in the Consumer Assistance Division do a great job and play an important role in the mission of this agency,” Commissioner Doak said.
Citizens with questions about insurance coverage or claims are encouraged to call OID Consumer Assistance at 1-800-522-0071 or visit www.oid.ok.gov.
Avoid Getting Overbilled for your Doctor's Visit
Consumers in need of help reach the Oklahoma Insurance Department Consumer Assistance Division in many ways. Spencer Albracht’s path started with an inquiry to News Channel 9’s Courtney Clevenger regarding suspicious medical billing.
Albracht knew something was wrong when he felt ill and suffered rapid weight loss. He contacted a physician within his insurance network and underwent an exploratory procedure in an effort to identify the ailment.
Unfortunately, subsequent troubles with medical billing made him a little ill, too.
The insurance company told Albracht he was responsible for a 30-percent co-pay, his share of the negotiated, in-network price of the doctor’s service provided. But after the insurance company paid 70 percent of the in-network fee and Albracht wrote a check for his 30 percent, the doctor’s office sent an additional bill to Albracht for $797.50 – the difference between the contracted fee for the service as negotiated by the insurer and the full price the doctor’s office would normally charge.
Albracht did some research and determined he was a victim of “balance-billing,” a practice prohibited when the patient is receiving in-network treatment. If a patient’s insurer has negotiated a discounted fee for services with an in-network provider, the patient is only responsible for paying his share of that contracted fee – he cannot be billed for any additional balance. In Oklahoma patients are not protected from “balance-billing” if the services provided are out-of-network.
Albracht contacted Channel 9 to complain. The news producer, Ms. Clevenger, both worked with the Oklahoma Insurance Department on a story about the case and suggested that Albracht file a formal Request for Assistance with OID to have his complaint addressed. Mike Rhoads, OID’s Deputy Commissioner of Life and Health Insurance, spoke on camera with News 9 to explain balance-billing and the consumer’s rights. Lydia Shirley, OID’s Consumer Assistance manager, directed the agency’s response to Albracht’s Request for Assistance.
Shirley found that the doctor’s office insisted that Albracht pay at least $600 to clear his account and avoid collections, while the insurer remained adamant that neither Albracht nor the insurance company owed the provider any additional payment. Ultimately the insurance company voluntarily paid the doctor’s office $600 to relieve the pressure on its policyholder, Albracht, and then canceled its in-network agreement with the doctor’s office due to the dispute.
While Albracht continues to recover and will need additional follow-up from a different doctor, he can rest a little easier knowing that his medical billing epic has ended thanks to the efforts of News Channel 9 and the Oklahoma Insurance Department.
“The insurance company really stepped up for me. I’m glad to be out of it,” he said. “I appreciate all the help I got from them, and from Channel 9 and the Insurance Department.”
Family's Recovery From Tornado Finally Begins When Insurance Settled in Full
As a massive tornado twisted its way across central Oklahoma on May 24, 2011, Vic Sanders instinctively told his wife and adult daughter by phone to leave the family home in Piedmont and seek shelter elsewhere before the storm could strike.
“Normally I’d say to stay indoors and take cover,” Sanders would later confess. “But sometimes you have to go with your gut.”
In this case, Sanders’ gut was right. The family returned to find the home severely damaged and near collapse.
“The walls were away from the foundation of the house,” Sanders said. “The brick at one end was leaning out at a 60-degree angle, about to fall. The house was just blown out. Everything was leaning.”
An insurance claim was filed, but to Sanders’ surprise the home was not considered a total loss. Repairs were recommended, rather than tearing down the house and rebuilding. For example, Sanders said the adjuster authorized paying to replace upper cabinets in the kitchen, but not lower cabinets. The adjuster suggested collecting bricks from the rubble and “cleaning them up to reuse.”
The insurer “wanted to pay for this end of the house and that end of the house, but try to save the middle,” Sanders said, still incredulous at the suggestion.
Sanders, whose livelihood is earned in light construction and remodeling, had an understanding of how serious the damage to the home really was. For nearly two months he pleaded with the company for a better settlement, one that would let the family start over from scratch. He made no headway, but refused to give up, especially when he returned to the hotel room where the family was staying while their insurance claim remained unresolved and found his wife in tears.
“I don’t know if we’ll ever have our house back,” she confided.
Sanders’ protective instincts kicked in again. He quietly vowed to do “whatever it took to give my wife a home.”
So when Vic Sanders was told by a friend a few days later that Oklahoma Insurance Commissioner John Doak was speaking at that moment to a breakfast gathering in Piedmont, he interrupted his work at a job site in Oklahoma City and drove back to meet the state’s chief insurance official. Sanders again found himself following his instincts.
“I looked at Mr. Doak and asked, ‘Are you somebody that can help me with an insurance problem or are you just somebody collecting a paycheck?’ My friend couldn’t believe I approached him that way, but I didn’t have time to waste with people who couldn’t help,” Sanders said. “Mr. Doak gave me 10 to 15 minutes of his valuable time and then said, ‘Let me see how I can assist you.’”
Sanders said the commissioner seemed sincere in his desire to help. It didn’t take long for him to find out. That same day, Deputy Commissioner Denise Engle called Sanders and asked to meet him at the damaged Piedmont home for a tour. Calls were made by the Insurance Department to Sanders’ homeowners policy carrier.
“Within a matter of 24 hours,” Sanders said, the insurer offered to reappraise the property damage. “Within 72 hours,” he continued, a settlement in full was offered on the homeowners policy, permitting the Sanders family to tear down the stricken home and build a brand new residence at the same address on Northridge Lane.
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Officials Cooperate to Aid Consumers After Unhitched Trailer Leaves Unresolved Insurance Claim
Accidents happen, and when they occur we expect that our insurance companies will quickly respond to our needs, making sure that repairs are made and our lives return to normal.
Unfortunately, reality does not always match expectations. Pamela Huddleston-Bickford and her husband Paul Bickford of Claremore recently experienced such a situation when a trailer came unhitched and crashed into their property, causing significant damage.
After months of frustrating phone calls with an insurance company the Bickfords were tired of being neglected and wanted a fair assessment of their damaged property. In an attempt to find help the Bickfords called state Sen. Sean Burrage’s office regarding their insurance claim.
In turn, Sen. Burrage contacted Insurance Commissioner John Doak to see what assistance the Oklahoma Insurance Department could offer the Bickfords.
“Commissioner Doak was amazing to gather needed information, follow up with the insurance company and communicate our needs clearly,” Huddleston-Bickford said. “Rather than months or even weeks we received a workable solution without legal action and headaches on our part. In fact, within hours we received a full settlement offer.”
The Bickfords said that they were proud that their senator and insurance commissioner worked in such a collaborative fashion, calling it a clear example of how government is supposed to work on behalf of citizens. Huddleston-Bickford said even the insurance company complimented the Oklahoma Insurance Department on its professionalism.
Said Huddleston-Bickford, “This is how we all dream that our statesmen would represent us and how our government ‘should’ work.”
Denial of Dental Benefits Overturned Through OID's Involvement
Erin and Brad Jerome of Edmond contacted the Oklahoma Insurance Department in February 2011 after Erin’s dental insurance denied full reimbursement for a procedure performed on two teeth. The Jeromes were informed that the insurer’s consultant determined the procedure did not meet the criteria to receive full benefits.
The Jeromes were concerned that the insurer’s consultant was not identified. They complained that without credentials to review, there was no way to know whether the insurance company’s consultant was qualified to determine authorization or denial of benefits.
Contacted by OID, the insurer identified its consultant and provided credentials. The insurer also spoke with Erin Jerome’s dentist to obtain more information on the case, and ultimately reversed its benefits decision, paying for the procedure. The benefits were issued and the Jeromes were sent a revised Explanation of Benefits.