State Office says it Helped Ohioans Save Record $24.4 Million

Lieutenant Ohio Governor and Insurance Director Mary Taylor announced the Ohio Department of Insurance saved or recovered a record $24.4 million for Ohio consumers in 2012 while assisting more than 190,000 Ohioans mainly through its toll-free hotlines, community outreach and counseling. The total includes $18.9 million and $5.5 million saved or recovered, respectively, by the agency’s Office of Consumer Affairs and its Ohio Senior Health Insurance Information Program (OSHIIP).

“The $24.4 million we helped Ohioans save last year is a testament to the important work we do each and every day,” Taylor said. “We continue to improve our processes, create efficiencies and strengthen our outreach efforts in order to better protect consumers.”

The Office of Consumer Affairs received 5,503 consumer complaints in 2012.  Two-thirds of which dealt with insurance claim denial, claim delay or unsatisfactory claim settlement offers.  OSHIIP, the state’s lead Medicare educational and enrollment program, counseled 38,276 Ohioans during Medicare open enrollment.

The following list shows the top types of consumer complaints for Ohio in 2012:

Top Types of Ohio Consumer Complaint Reasons:

• Denial of Claim – 26.8%
• Claim Settlement/Payment Delay – 13.6%
• Claim Settlement/Unsatisfactory Offer – 11.8%
• Underwriting/Premium Rating – 4.9%
• Underwriting/Policy Cancellation – 4.4%

Top Types of Ohio Complaints by Coverage:

• Accident and Health – 40.6%
• Personal Auto – 21.8%
• Homeowners and Renters – 17.4%
• Life and Annuity – 14.4%
• Other Coverage – 5.8%

This information is based on the submission of closed complaint data to the National Association of Insurance Commissioners (NAIC). Aggregate data can be accessed at www.naic.org.

Insurance Claim Tips:

• Know Your Policy: Your policy is a contract between you and your insurance company.  Know what’s covered, what’s excluded and deductible amounts.
• File Claims as Soon as Possible: Call your agent or your company’s claims hotline right away.
• Provide Complete, Correct Information: Incorrect or incomplete information can cause a delay in processing your claim.
• Ask Questions: If there is a disagreement about the claim settlement, ask the company for the specific language in the policy that is in the question.  Find out if the disagreement is because you and the insurance company interpret your policy differently.  If this disagreement results in a claim denial, make sure you obtain a written letter explaining the reason for the denial and the specific policy language under which the claim is being denied.
• Do not Rush into a Settlement: If the first offer made by an insurance company does not meet your expectations, be prepared to negotiate to get a fair settlement.  If you have any questions regarding the fairness of your settlement, seek professional advice.
• Health Claims: Ask your physician to provide your insurance company with details about your treatment, medical conditions and prognosis.  If you suspect a provider is overcharging, ask the insurance company to audit the bill and verify whether the provider used the proper billing procedure.

Ohio consumers who would like to file a complaint or have insurance questions can call the Department’s consumer hotline at 1-800-686-1526 or visit www.insurance.ohio.gov. If your inquiry is Medicare related, call OSHIIP at 1-800-686-1578. You can follow the Ohio Department of Insurance and OSHIIP on Facebook.