You're having a dispute with your insurance company regarding a claim.The insurance company refuses to pay you a dime, you think you're entitled, and you've reached an impasse. Whom do you call for help--a lawyer or your state insurance commissioner?
Asking your state insurance commission for help is free to you and any other resident across the United States, and the commission has the power to mediate on your behalf. That's usually enough pressure to get your agent to cooperate. It can also fine your insurance company for wrongdoing or, as a last resort, take away its license to sell insurance in your state.
But the commission has no power to mandate how much you should be paid for your claim--it can only make a yes-or-no decision about whether your policy covers the situation for which you've made a claim. If your dispute is over the monetary amount of your claim, a lawyer might be more helpful than the commission.
"It really depends on the problem," says David Langenbacher, deputy commissioner for Consumer Services and Market Conduct with the California State Insurance Department. "We're successful in resolving many things, and if we can't, you still have the option of seeking the advice of an attorney."
Claire Tristram is a business and technology writer in San Jose, California.
New York's Experiment
Last January, the city of New York launched a two-year pilot project to help small businesses with two to 50 employees offer their staff members health insurance. The Small Business Health Insurance Program works as a purchasing alliance--it allows businesses to pool together, which makes them eligible for less expensive benefit plans from insurers. Program rates range from about $100 for individual employees to $235 for family coverage. New York City small-business owners can purchase the plan through their insurance broker, just like any other policy.
The program could be a win-win situation for both entrepreneurs and the city of New York. Entrepreneurs win with reduced premiums for their employees.The city wins, too, by reducing the financial burden of uninsured people using public hospital emergency rooms as walk-in clinics. But there are drawbacks, too: Employers who sign up must cover all their employees, and members of the plan can only use the services of three public hospitals, rather than choosing their own health-care providers. If the program succeeds, expect to see far more municipalities following the Big Apple's lead.
Six years ago, when President Bill Clinton signed the Family and Medical Leave Act into law, small-business owners everywhere breathed a sigh of relief:While the law required businesses to provide employees with up to 12 weeks for family and medical leave each year, businesses with fewer than 50 employees were exempt from the provision.
During the State of the Union address in January, however, the president pledged to extend the law's provisions to small businesses, too.Although at press time there was no active drive in Congress to pursue the president's pledge, it's probably still a good idea to contact your congressional representative if you have concerns about how lifting the exemption on small businesses would affect you.
That's not to say that Congress hasn't been busy with insurance-related issues: A wave of legislation is currently being debated in both houses that seeks to protect patients' by regulating HMOs. The legislation includes bills that allow patients direct access to specialists without getting permission from their HMO, mandatory minimum lengths of stay in hospitals for certain procedures, and outside review for patients challenging denial of care, among other things. To track these bills, log on to the THOMAS site, run by the Library of Congress at http://thomas.loc.gov, and enter a search for the keyword "insurance."