For Immediate Release: January 31, 2011
Commissioner Goodwin Announces More Than $40 Million in Recoveries and Savings for North Carolinians
In tough economic times, the Department of Insurance fights to protect consumers
RALEIGH -- Insurance Commissioner Wayne Goodwin today released the 2010 statistics for the Department of Insurance's Consumer Services, Agent 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 approximately 85,000 calls and received nearly 8,700 written complaints from the public. Through these calls and complaints, the Department was able to help citizens recover more than $10.1 million from insurance companies.
- The Agent Services Division regulates all licensed agents, brokers, limited representatives, appraisers, adjusters, premium finance companies, collection agencies, motor clubs, bail bondsmen, surety bondsmen and bail bond runners authorized to do business in North Carolina. Oversight includes licensure qualification, pre-licensing education, continuing education, telephone inquiries, complaint investigations and agency examinations. The Division investigated more than 1,300 complaints and recovered $82,446.40 in premium funds for consumers.
- The Healthcare Review Division returned $477,068.22 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 $1,559,907.31 returned to policyholders.
- The Criminal Investigations Division employs 20 sworn law enforcement officers dedicated to investigating claims of insurance fraud and criminal concerns associated with bail bonding, motor clubs, collection agencies and premium finance companies. In 2010, these criminal investigators saw more than 400 cases successfully closed with more than $21.1 million in restitution and recoveries, 88 criminal convictions and 126 arrests.
- The SHIIP (Seniors' Health Insurance Information Program) Division assisted more than 110,000 consumers with general Medicare questions and helped enroll more than 5,500 Medicare recipients in the Low-Income Subsidy program that provides savings for prescription drug costs. The estimated cost savings for Medicare beneficiaries was $8,625,699. The SHIIP 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.
"I'm proud that the amount of recoveries and savings for each of our consumer protection-oriented divisions increased in 2010, in some cases dramatically from the previous year," said Commissioner Goodwin. "In these tough economic times, the Department of Insurance is constantly improving at getting money back to deserving North Carolinians. We're here to help."
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 877-885-0231. If you would like to report suspected insurance fraud, call the Criminal Investigations Division at 919-807-6840; callers may remain anonymous. For Medicare-related questions or complaints, call SHIIP directly at 1-800-443-9354 or visit their Web site by clicking on this link.
Consumer information, downloadable publications and an online suggestion box are available at the N.C. Dept. of Insurance Web site here.