Consumer Services Section

In disputed insurance claims, the Consumer Services Section staff acts as a liaison between the consumer and the company. Statistics are produced on each insurance company’s complaints, which become one criterion for setting market conduct examination priorities.

The Consumer Services Section staff assists the public with information on insurance companies, health services corporations, HMOs and third party administrators. Consumers may obtain information from Insurance about a company’s financial status, license status, complaint record and other insurance-related information.

Twenty people operate the Consumer Services Section offices in Jefferson City, St. Louis and Kansas City. The Jefferson City office provides a nationwide toll-free number, 800-726-7390, to assist consumers and a TDD line for the hearing impaired, 573-526-4536.

Thousands of consumers contact Insurance each year for answers to insurance questions. In calendar 2002, Consumer Services Section staff assisted 61,742 persons over the telephone and 420 persons that walked into one of Insurance's three offices. Consumer specialists in the three offices handled 5,716 formal complaints against insurance companies and administrators and 2,250 written requests for information, in addition to mailing thousand of brochures. Consumer Services recovered $10.5 million for Missourians from insurance companies that denied claims, denied premium refunds or otherwise failed to meet their legal obligations to the consumer.

The Consumer Service Section often identifies trends evolving in the insurance industry. In 2002, evolving trends identified through consumers include the use of credit scoring as criterion for premium rating, the nonrenewal of homeowners policies because of weather- related claims and the inadequacy of the Fair Plan's $100,000 limit on homeowners' coverage. Identifying trends enables Insurance to assist lawmakers with identifying areas for statutory improvements.

Insurance can refrain an independent physician to review a health insurer's refusal to pay for care. CIMRO, a contractor, provided such physician reviews under contract in 2002.

The U.S. Center for Medicaid and Medicare Services enforces compliance with the Federal Health Insurance Portability and Accountability Act (HIPAA) in Missouri. The passage of this law in 1996, extended new protections against the loss of health insurance coverage, limited the use of pre-existing condition exclusions and expanded employer options for providing group coverage. The Consumer Services Section accepts complaints and inquiries and conducts HIPAA-related investigations to assist the federal agency in its enforcement activities.

The Community Leaders Assisting the Insured of Missouri (CLAIM) provide senior health insurance counseling under contract with Insurance. It uses federal grant money and state general revenue through the Department of Health and Human Services to offer counseling on Medicare and other insurance using volunteer counselors. Since the program began in 1993, CLAIM has saved Missouri’s citizens more than $6.5 million and assisted more than 82,527 seniors. CLAIM has more than 260 active volunteers and a toll-free hotline, 800-390-3330.