Editorial: State needs to improve health insurance appeal process

Published Aug 26, 2014 at 12:02AM

Anyone wondering why health insurance doesn’t cost less should look at Oregon’s state Insurance Division.

Oregon Health CO-OP wanted to sell its health insurance for 21 percent less in 2015. The state of Oregon, which has the power to regulate the rates, said no. The insurer could lower its prices by 9.9 percent.

The state may have good reasons for being cautious. It doesn’t want an insurer to not have enough money to cover all of its claims.

But what doesn’t make sense at all about the state’s position is what Oregon’s Health CO-OP could do when it disagreed with the state’s position.

The company asked for a meeting with the state regulators. The regulators said they would agree only to a conference call.

Why was that? Conference calls can be good enough, but they aren’t a substitute for an in-person meeting. We called the state’s Insurance Division to ask. We didn’t get a call back.

More importantly, the state also told Oregon Health CO-OP if it didn’t agree to the 9.9 percent decrease, it faced the very real possibility that an appeal would not be completed in time. That left Oregon Health CO-OP with not much of a choice. It could take the 9.9 percent or gamble with the appeal and perhaps not be able to sell health insurance in Oregon in 2015.

If the state of Oregon is going to dictate health insurance rates, it needs to give insurers adequate time for appeal.