Insurance Commissioner Wayne Goodwin today released the 2009 statistics for the Department of Insurance's Consumer Services, Healthcare Review, Market Regulation, Criminal Investigations and SHIIP Divisions:
•The Consumer Services Division, which handles consumer inquiries and complaints about insurance-related issues, handled some 90,000 calls and processed more than 8,500 written complaints from the public. Through these calls and complaints, the Department was able to help citizens recover more than $9 million from insurance companies.
•The Healthcare Review Division returned $175,540.32 to consumers who received an external review because of a health insurance claim denial. When health insurance claims are denied, Healthcare Review works with consumers to complete their insurers' appeals and grievances procedures; if a denial is deemed to be for a service that is medically necessary, the consumer can request an external review through the Division. External reviews provide a second look at the denial by a third party expert.
•The Market Regulation Division conducts both routine and targeted market conduct examinations on foreign and domestic licensed companies (insurance companies, premium finance companies, HMOs, PPOs, and more) to ensure compliance with state laws and regulations. Through these exams, the Division ordered $981,300.81 returned to policyholders.
•The Criminal Investigations Division employs 20 sworn law enforcement officers dedicated to investigating claims of insurance fraud. In 2009, these criminal investigators saw more than 413 cases successfully closed with more than $10.5 million in restitution and recoveries, 89 criminal convictions and 175 arrests.
•The SHIIP (Seniors' Health Insurance Information Program) Division assisted more than 76,000 consumers with general Medicare questions and helped enroll more than 2,600 Medicare recipients in the Low-Income Subsidy program that provides savings for prescription drug costs. The Division offers free, unbiased information about Medicare, Medicare prescription drug coverage, Medicare Advantage, long-term care insurance and other health insurance information. SHIIP's trained volunteers provide one-on-one counseling in all 100 counties. For Medicare-related questions or complaints, call SHIIP directly at 1-800-443-9354 or visit www.ncshiip.com.
"I'm proud that through our work at the Department we could get $20 Million in money back for consumers across North Carolina," said Commissioner Goodwin. "This year's numbers are especially eye-opening but certainly great news knowing that so many families have struggled financially this past year. Consumers need to know that the Department of Insurance is here to help them. Our strong, state-based insurance regulatory oversight here in North Carolina is a vital component to the consumer protections evident in our 2009 recovery statistics."
Anyone with questions about insurance can call the Department's Consumer Services Division at 800-546-5664 to speak with an insurance expert. If your health insurance has denied your claim, you may also contact the Healthcare Review Division at 1-877-885-0231. Further anyone with insurance fraud suspicions should call the Criminal Investigations Division at 919-807-6840; callers may remain anonymous.
Consumer information, downloadable publications and links to the Department's social media sites and online suggestion box are available at www.ncdoi.com.
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*Based on publicly available report at this link.