Consumer Alert: Liberty Mutual Policyholders Experienced Difficulty Filing Claims, Receiving Response

Company corrections ordered and completed

Commissioner Trinidad Navarro has released a consumer alert for Liberty Mutual policyholders. In early December, the Delaware Department of Insurance became aware of unacceptable difficulties in contacting the company and filing claims by phone. The department ordered these issues corrected when discovered, and recently deemed the problems resolved.

Policyholders reported long wait times and dropped calls when contacting Liberty Mutual by phone, as well as an inability to connect with a live representative. The company’s system was also pushing consumers online to file a claim.

“The digital divide is still present in our state, and consumers must have access to claim filing processes by phone. A person’s access to the internet or technology should not define the level of difficulty they encounter in interacting with their insurer, or amount of time it takes to file a claim,” said Commissioner Navarro.

Liberty Mutual actively worked with the department to investigate the issues when they were uncovered and has now resolved the problems.

If you are a Liberty Mutual policyholder and you continue to encounter this issue, or if you are experiencing an insurance problem with another company, contact the Delaware Department of Insurance’s Consumer Services Division by emailing consumer@delaware.gov or calling (302) 674-7300.


State Auditor Kathy McGuiness and Insurance Commissioner Trinidad Navarro Partner for a Fraud Town Hall

DOVER, DELAWARE – Delaware State Auditor Kathy McGuiness and Insurance Commissioner Trinidad Navarro together will host a virtual Fraud Town Hall via Facebook live on Wednesday, October 21, 2020 beginning at 3:00 pm.

The Auditor’s Office and the Department of Insurance want to jointly raise awareness of the types of fraud schemes both agencies regularly encounter and ways consumers can protect themselves from becoming victims.

“Over the past several months, we’ve seen an increase in fraud complaints brought on by the coronavirus pandemic,” said State Auditor Kathy McGuiness. “Our responsibility as a watchdog is to ensure proper safeguards and internal controls are in place to combat it.”

“As the largest consumer protection office in the state, the Department of Insurance reviews more than 525 fraud referrals a year, filing 531 civil and 15 criminal cases last year,” said Insurance Commissioner Trinidad Navarro. “With new technologies entering the insurance and healthcare arena, and Open Enrollment for Medicare and the Affordable Care Act taking place in the coming months, it is more important than ever that we work together to detect, prevent, and respond to fraud.”

Delawareans are understandably fearful of the repercussions from the health and economic crisis and rightfully want to know what their elected officials are doing to protect them from fraud and scams. The Fraud Town Hall will provide them answers.

Watch live at FB.me/DeTv302.

Learn about the Delaware Auditor’s Office and Department of Insurance online at https://auditor.delaware.gov and https://insurance.delaware.gov/.

Contact: Alaina Sewell, Executive Assistant, Alaina.Sewell@delaware.gov, 302-857-3931

 


$21.5 Million in Health Insurance Rebates for Individuals and Small Businesses

Thousands of Highmark 2019 plan participants and groups to receive checks

After announcing a reduction of Delaware Health Insurance Marketplace rates for the upcoming enrollment year, Insurance Commissioner Trinidad Navarro has more good news for residents who purchase insurance on the Delaware Health Insurance Marketplace, those who purchase Highmark Blue Cross Blue Shield Delaware plans outside of the exchange in the individual market, and for Highmark small group policyholders, announcing more than $21.5 million in rebates for 2019 participants.

“Now, more than ever, we need to make sure that every resident and small business can afford the health insurance they need for their families and employees. These rebates, combined with the ACA health insurance rate reduction for the coming year, do just that,” said Commissioner Navarro. “This is just one of many ways we are working to reduce the cost-of-care our residents experience in the health care system.

For the first time in the history of Delaware’s individual health insurance market, more than $12.6 million will be returned to 19,273 policyholders, with the average rebate being $656. Highmark small groups, often small businesses, will receive more than $8.8 million in cumulative return. 2,779 groups will receive an average rebate of $3,198, with more than 175 groups receiving rebates over $10,000. Employers can consider using these dollars to enhance benefits, reduce premiums for employees in future policy years or provide refunds directly to group health plan participants.

Communications will be sent to policyholders in September and checks for both individual policyholders and small groups will be sent the week of September 21. Those in the individual market with rebate questions can contact Highmark at 800-544-6679. Small group employers with rebate questions can contact their insurance producer, or Highmark at 800-241-5704.

These rebates are required by the Delaware Department of Insurance according to Medical Loss Ratio (MLR) measurements set by the Affordable Care Act, which are meant to ensure that insurers are spending a majority of premiums on health claims and clinical services, not taking those dollars for profit or administrative expenses. The rebate system creates balance when data shows that this ratio was off in a previous year. Not every policy will receive a rebate. MLR review for the 2020 plan year will shine a light on changes in insurance usage due to COVID-19 and will be released in 2021.

On August 31, Commissioner Navarro announced the Delaware Health Insurance Marketplace would see an average decrease in rates of 1% for individual plans. Highmark small group plans will see an average premium decrease of 3%.


Commissioner Navarro Statement on Sixth Modification to State of Emergency

In consultation with the Delaware Department of Insurance, Governor John Carney today issued a sixth modification to the state of emergency that requires that insurers cease cancellations or nonrenewals of insurance policies due to nonpayment throughout the duration of the declared Delaware State of Emergency for those residents and business owners who are experiencing a loss of income. In declaring a Public Health Emergency earlier this week, the Governor specified that health insurers are to waive all prior authorization constraints for lab testing and future treatment of COVID-19. Commissioner Navarro previously recommended insurers take these actions in a bulletin to the industry.

“We are grateful for Governor John Carney’s leadership during the COVID-19 crisis. Whether it is ensuring care without delay by removing prior authorizations in the short-term, or limiting the long-term effects of the virus’s economic impact by helping people keep their insurance, this thoughtful, detailed approach is just what our state needs,” said Commissioner Navarro.

Delaware’s insurance carriers will freeze cancellations and nonrenewal of policies that might have otherwise occurred due to delays in payments through the duration of the state of emergency for individuals who have been laid off or fired due to the state of emergency or organizations who have had to close or significantly reduce business. A carrier would now be required to seek a court order before they could cancel or nonrenew any health, life, disability, property, auto, and commercial/business insurance policies.

In addition to the immediate assistance, this action helps to reduce the long-term impact of the virus on insurance, because if policies were not renewed or were cancelled, it could have hindered future insurance policy approvals or increased premium costs for those individuals and businesses due to the cancellation or nonrenewal creating a lapse of insurance.

Read the Governor’s Emergency Declaration


Delaware Issues RFP for Office of Value-Based Health Care Delivery

Delaware’s Department of Insurance is pleased to announce that it is actively recruiting for a qualified independent contractor to staff and run its new Office of Value-Based Health Care Delivery. The Office will assist the Insurance Commissioner and Delaware’s Primary Care Reform Collaborative in evaluating primary care accessibility and affordability statewide.

“Reducing health care costs in Delaware is a key priority of my administration,” said Insurance Commissioner Trinidad Navarro. “The team leading our Office of Value-Based Health Care Delivery needs to possess a high level of expertise in health care transformation and innovation. Together with the Primary Care Reform Collaborative, we intend to identify quantitative tools that will help increase the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.”

Earlier this year, members of the General Assembly passed Senate Substitute 1 for Senate Bill No. 116, in order to create the Office. The Office was a recommendation of the Primary Care Reform Collaborative, which is tasked with evaluating the high costs of care in Delaware. In the months since passage, the Collaborative has been working hard to develop recommendations to strengthen Delaware’s primary care system.

“The legislature’s consideration of pro-consumer bills has allowed us to continue to foster an environment where residents are prioritized over profits,” said Leslie W. Ledogar, Esq, the Commissioner’s representative within the working group. “The Office of Value-Based Health Care Delivery epitomizes that vision, and we are grateful for everyone who spent time working on this effort.”

The Request for Proposal may be downloaded from the Office of Management and Budget website. Applicant questions should be directed to the Department’s Regulatory Specialist Leslie W. Ledogar, Esq.