Press Release 2000-23 State Insurance Department Advises Medicare + Choice Members to Make Changes Now if They Are Losing Coverage

NEW AGENCY


Arizona Department of Insurance
100 North 15th Avenue, Suite 261

Phoenix, AZ  85007-2630


Starting July 1, 2020, we became the
Department of Insurance and Financial Institutions (DIFI).


Media Contact: Don Harris, Public Information Officer, (602) 912-8402

For Immediate Release December 26, 2000

Arizona Insurance Director Charles R. Cohen reminded Medicare beneficiaries that some of them will be losing their Medicare+Choice HMO coverage after Dec. 31, 2000, and that now is the time to take action to secure other coverage, if they have not already done so.

Effective Jan. 1, 2001, 11 of Arizona’s 15 counties will have no Medicare HMO plans. Counties that will continue to have Medicare HMOs are Maricopa, Pima, Pinal and Santa Cruz. Counties that are losing their Medicare HMO plans effective Jan. 1, 2001, are Cochise and Gila. Other counties without any Medicare HMO plans are Apache, Coconino, Greenlee, Graham, La Paz, Mohave, Navajo, Yavapai and Yuma.

The deadline for obtaining other coverage is March 4, 2001.

Arizonans who already have original fee-for-service Medicare will not be affected by the HMO changes. The recent notices affect only those individuals who receive their coverage through a Medicare HMO.

Some Medicare beneficiaries who lose their Medicare HMO coverage have the option of switching to a different Medicare HMO. All Medicare beneficiaries always have access to original fee-for-service Medicare. In addition, many will have the right to purchase a “guaranteed-issue” Medicare Supplement policy for a certain time. A Medicare Supplement policy is designed to supplement original fee-for-service Medicare. While some Medicare Supplement plans provide prescription drug coverage, the plans that are available under the guaranteed issue rules do not provide drug coverage. “Guaranteed issue” means the insurance company can’t turn you away, Cohen explained.

Consumers who are losing their coverage should have received an official termination letter from their plan during the first week of October. Consumers who decide to buy a guaranteed-issue, Medicare Supplement policy will need to send a copy of the letter with the application to the Medicare Supplement insurance company.

Here are the options:

  • Consumers can purchase a Medicare Supplement policy during the first 63 days of 2001. These affected members can purchase a guaranteed-issue Medicare Supplement Plan A, B, C, or F without any exclusions for preexisting conditions or a waiting period. This supplement insurance is available from any insurer that markets the four plans listed above, as long as the beneficiary applies for the plan before March 4, 2001.
  • Consumers can purchase another type of Medicare+Choice plan called a Private-Fee- For Service plan, which is available in all Arizona counties, but does not include prescription drug coverage.
  • Consumers can join another Medicare HMO plan that still accepts new enrollees, if there are other HMOs in the county where the consumer lives. Two plans in Pima County are withdrawing from the Medicare+Choice program, but other coverage is still available there.
  • However, Medicare beneficiaries who are under 65 have limited choices. Not all Medicare supplement insurance companies offer coverage to this group. Of the companies that do offer coverage, only Plan B is available.

Medicare+Choice HMO plans available by county, effective Jan. 1, 2001, are:

Maricopa (including Apache Junction): Aetna U.S. Healthcare; CIGNA Healthcare of Arizona; Humana Health Plan of Arizona; Intergroup of Arizona; Pacificare of Arizona; Sun Health Medisun (Western Maricopa County only).

Pima: Intergroup of Arizona; Pacificare of Arizona.

Pinal: Intergroup of Arizona; Pacificare of Arizona.

Santa Cruz: Intergroup of Arizona.

For more information, consumers can call the State Health Insurance Assistance Program, (SHIP), at 1-800-432-4040; the Arizona Department of Insurance Consumer Affairs Division at (602) 912-8444 or statewide at 1-800-325-2548, or 1-800-MEDICARE (1-800- 633-4227). Information is also available on the Insurance Department’s web site at www.state.az.us/id or at www.medicare.gov which is the federal government’s web site.

“We recommend that consumers get all the facts before making any decisions,” Cohen said. “The best advice we can give Medicare beneficiaries is to shop around for the best rates on Medicare Supplement insurance, if they want to purchase coverage to supplement the gaps in traditional fee-for-service Medicare. The time to do that is now.”

-30-

Period: 
2000
Priority: 
23
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Arizona's Surprise Bill Resolution Report for 2019

As shown in the attached report prepared pursuant to A.R.S. § 20-3118(A), the Department of Insurance received 91 requests for dispute resolution in Calendar Year 2019.  Of those, 53 have been resolved or closed, and health plan enrollees saved $41,538 by submitting their surprise bills for resolution.  

Not all health care bills qualify for the surprise bill resolution process.  The Department's Suprise Out-of-network Billing Dispute Resolution website (https://insurance.az.gov/soonbdr, and especially the section entitled, "I got a surprise bill. Can I submit a request for arbitration?") lists conditions when a health care bill may not qualify under Arizona law for the dispute resolution process.  But for those that do, the enrollee will only be responsible for paying the enrollee's cost-sharing amounts (copay, coinsurance and deductible) if the enrollee provides information the Department needs, and participates in an informal settlement teleconference with the health care insurer and the health care provider.

Fire Readiness and Your Insurance Coverage

Complete three steps to be prepared

STEP ONE: Inventory your contents. 
Making a record of what you have provides two major benefits.  First, it could help you estimate the cost of replacing your contents, which you could use to make sure you have enough insurance coverage.  Second, it will help you identify missing or destroyed items if you need to file an insurance claim. Keep your inventory records in a safe place outside your home, such as a safe deposit box at a bank, or in a secure online location. 

  • The National Association of Insurance Commissioners (NAIC) has a free app called, “MyHome Scr.APP.book,” available from Google Play and from the Apple App Store, which can help you keep track of your personal property. 
  • The Insurance Information Institute provides advice that can make creating a home inventory easier (https://www.iii.org/article/how-create-home-inventory).

STEP TWO: Understand what your homeowners’ insurance policy covers.
If you do not have your policy on hand, get a copy from your insurance company or insurance agent. Then, make sure your policy provides enough coverage for your dwelling, contents and additional living expenses.

  • Dwelling Coverage:  This pays to reconstruct your home, from ground up if necessary.  It does not include the cost of the land on which your home sits because you will still have that, but it should include the cost to remove a destroyed structure and replace it a home that is similar to what you had prior to the fire.
  • Contents Coverage:  This pays to repair or replace your personal belongings. Your policy may provide contents coverage based on a set percentage of your dwelling coverage, but you can pay for more contents coverage if you think you need it. 
    • Check to see if your coverage will pay “actual cash value” or “replacement cost.”  Actual cash value (ACV) means what an item was worth when it was destroyed based on its initial cost minus depreciation or loss in value due to its age, condition and wear-and-tear.  Replacement cost (RC) means the cost to replace or repair damaged or destroyed property with materials of “like kind and quality”. Claims for damaged or destroyed items will initially be paid based on the ACV of the item.  When the item is replaced, a copy of the receipt must be provided to the insurance company to obtain payment of the balance owed.  Many policies require the damaged items to be replaced within six (6) months.
    • If you have expensive items, such as artwork, jewelry or computers, you can purchase or increase “scheduled” property coverage to make sure you have sufficient coverage for those items.
  • Additional Living Expense (a.k.a. Loss of Use) Coverage. This pays additional costs you may resulting from the property damage.  For example, if you are not able to live in your home, your policy may cover the costs of lodging and food, boarding your pets, etc.

Importantly, insurance policies are often lengthy, detailed documents.  Do not hesitate to contact your agent or insurance company representative if you have any questions. 

STEP THREE: Minimize your fire risk.
Periodically inspect your home for overloaded power strips, damaged electrical cords or other potential fire hazards.  Keep vegetation and combustible materials away from your home.  If you are in an area that is at higher risk for wildfire, follow “Avoiding Wildfire Damage” guidelines published by the Federal Emergency Management Agency (https://www.fema.gov/pdf/hazard/wildfire/wdfrdam.pdf). 

Remain organized and keep good records

If you are the victim of a fire, remaining organized after an event can be difficult, but it is essential so that you can receive the benefits that your insurance coverage provides.

  • Keep all receipts for living expenses (housing, food, etc.) and for all items that you replace or repair.  Insurance companies may require that you submit original receipts. You should either copy, scan or take clear photos of receipts to provide yourself a backup. 
  • Take photos of your property and the damage.
  • Keep records of all your conversations, emails and letters about your claim with your insurance company and agent.  Take notes of conversations, documenting who you talked to, when you talked to them and what you were told. When possible, send an e-mail message to the person with whom you had the conversation to confirm your understanding of what you were told.
  • Do not throw away or destroy damaged property until your insurer inspects the property and tells you in writing/e-mail that you can do so.
  • Take an inventory of the damaged contents.  If you have an inventory from before the fire, use it to help identify items that were damaged/destroyed. 
  • When the insurer inspects the damage, do a complete walkthrough of your property and point out any issues or concerns you have.
  • When beginning the repair process, get multiple repair estimates from licensed contractors (look up records on the Arizona Registrar of Contractors “Contractor Search” page at https://roc.az.gov/contractor-search) with good reputations (look up records on the Better Business Bureau website at https://www.bbb.org).
  • Don’t delay.  Insurance policies generally have restrictions on how long after a fire you can file claims.

Persons with disabilities may request materials in an alternative format by contacting our Americans with Disabilities Act Coordinator at (602) 364-0108. 

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