"The Big Picture" Newsletter

January 2008 Issue

WASHINGTON EDITION

Office of the Insurance Commissioner Investigates Rule Requiring Providers to Identify Providers When Denying Coverage

The Office of the Insurance Commissioner (OIC) issued an inquiry on December 10 for a potential rule that would require life, disability, and property and casualty insurers to identify a medical professional or other source of information when providing an enrollee the actual reason for canceling, denying, or refusing to renew insurance. The existing regulation allows an insurer to give a "broad reference" to the reason for denial when the actual reason for the denial relates to medical information. The OIC is accepting written comments until February 29, 2008.

On December 11, the Department of Health issued a revised version of a draft rule requiring health insurers to report physicians engaged in billing fraud or other “unprofessional conduct” The new language limits the reporting to "any decision" that an insurer makes that concludes a licensed provider has engaged in billing fraud or “unprofessional conduct.”

 

LOCAL SPOTLIGHT

Where We Are

Washington business is managed out of our Seattle, Washington office:
CIGNA HealthCare
701 5th Avenue, Suite 4900
Seattle, WA 98104
Telephone: 206.625.8892
Fax: 206.625.8880

Who to Contact

Ed Eberhard
206.625.8886
Edwin.Eberhard@cigna.com

Experienced Local Leadership

Daryl W. Edmonds, President and General Manager
Daryl Edmonds joined CIGNA HealthCare, as president and general manager of the Colorado health plan, in 1997. Responsible for sales and operations, Edmonds has led his management team into the 21st century as one of the only managed care organizations in the state to achieve profitability and maintain steady growth for the past eight consecutive years. Edmonds is President and Market Leader for Colorado, New Mexico, Utah, Wyoming, Montana, Idaho, Alaska, Washington and Oregon.

Edmonds, who has 19 years experience overseeing health plans, is a graduate of Kansas State University with a Bachelor of Science degree in business. He is active in the Denver Metro Chamber of Commerce; serves on the board of directors of the March of Dimes as well as Cover Colorado and was a past board member of Junior Achievement; was past president of the Colorado Association of Health Plans; and serves on the Business Council on Healthcare Competition.