Once again, a Washington Appellate Court has ruled that an insurer’s blanket denial of payment of a medical bill that exceeds a predetermined amount constitutes an unfair practice in violation of the state Consumer Protection Act. [Stan Schiff v Liberty Mutual Fire Insurance Company, No. 82554-2-1 Decided 11/28/2022 footnote 8 at 12] “Insurers must make…
This past legislative session, the Washington House of Representatives considered regulation of third party administrators (TPAs) as recommended by the state Insurance Commissioner. After some confusion over what the Commissioner intended and what should be amended, the bill died a quiet death in committee. Policymakers quickly discovered that TPA regulation had become a surrogate for indirectly addressing…
Finding, reading, and understanding the thousands of regulations that apply to health plans can drive a sane person to drink Flint, Michigan water. But not me. My sanity has already been questioned given that I intentionally spent a lot of money to go to school so I could learn the discipline of memorizing convoluted regulations…
The Washington Insurance Commissioner has requested legislation for registration of third party administrators to protect consumers. Third party administrators (TPAs) come in all shapes and sizes and just as many flavors. Insurers typically provide most services for administration of its own health plans. Many Insurers also sell administrative services to self-funded plans which would make…
The ranking member of the Washington State House Health Care Committee, Representative Joe Schmick, read my recent association health plan (AHP) post and shared the Insurance Commissioner’s letter explaining the agency’s recent actions. In his letter, the Commissioner addresses the administrative law judge’s decision disapproving the agency’s rating requirements. Disagreement over bona fide status was…
When I jokingly posted my “Ground Hog’s Day” video” here two years ago, I had no idea how depressingly accurate that joke would become. Our experience with federal health care reform has mirrored past attempts at reform through regulation. As I noted here when the Affordable Care Act was signed, it’s not the absence of…
