Consumer Assistance Program,
Office of the Montana Commissioner of Securities and Insurance

This program reaches out to and advocates for consumers in this large rural state.

Program Structure and Services

The Montana Commissioner of Securities and Insurance, also known as the Montana State Auditor, is responsible for regulating all types of insurance, and it has operated with the mission of protecting the interests of consumers since 1889. Most of its funding comes from fees on insurers. Eleven full-time staff members work with health care consumers in all types of plans, compile complaint data, and produce analyses to facilitate market oversight. Consumers can request information and assistance by phone, mail, email, fax, online, or in person.

The office helps consumers work through any type of insurance problem, including billing, access to care, enrollment, denials of claims, and underwriting and contract disputes. Staff also advocate on behalf of consumers with insurance companies, assist consumers in filing appeals with their health plan, and submit requests for independent external review on behalf of consumers. The program helps Medicare beneficiaries enroll in Part D drug coverage and use the Medicare online plan finder. It refers Medicaid and Healthy Montana Kids Program beneficiaries who call to the Montana Department of Public Health and Human Services.

In addition to the functions listed above, the commissioner’s office can take legal action to correct violations of the state’s insurance laws or instances of insurance fraud. The office also regularly issues advisory memoranda to insurers that provide information on compliance with new regulations and the implementation process for new laws. The office identifies and then addresses policy problems by changing administrative rules or by proposing legislation. For example, the commissioner was influential in urging the state to pass legislation that regulates the sale of medical discount cards to fight fraud and abuse.

For fiscal year 2010, the staff resolved 615 written complaints, recovering $206,758 for consumers and restoring health coverage for many others. (The program did not begin documenting telephone inquires that were resolved in conversation or referred to another agency until its current fiscal year.)

How Did Consumer Assistance Grant Funding Help the Commissioner’s Consumer Assistance Program?

As a result of the $149,880 consumer assistance grant, the consumer assistance program was able to invest in training that focused on providing more in-depth assistance for consumers in the appeals process and help for those in self-funded health plans. The program has also upgraded its telephone and database technologies, which has allowed staff members to more efficiently track all of the inquiries it receives and the outcome of each case.

Public Education and Outreach

Increased funding has given the commissioner’s office more tools to conduct broader outreach to health care consumers. Montana is a large, rural state, which makes in-person outreach a significant challenge. To reach communities across the state, staff members travel extensively, holding public seminars and distributing educational materials to inform consumers about new coverage options, protections, policy changes, and common insurance-related issues and how they can contact the commissioner’s office if they need help. The staff has also held forums for medical providers about how the Affordable Care Act will affect them and their patients.

From 2010 through 2011, the commissioner’s office conducted in-depth seminars in nine Montana cities, advertising the seminars through radio ads and mailings. In 2011, the consumer assistance program used part of its grant to establish an educational tour called “Office Hours in Your Town,” which brings consumer assistance staff to educational events throughout the state and makes in-person counseling available to local residents.

The commissioner’s office also produced two public service announcements that tell the stories of two Montanans who had problems with their health insurance—until they called the commissioner’s office. The PSAs highlight the office’s role as an advocate for consumers and encourage people to contact the office with questions and complaints.

In October 2011, the commissioner’s office unveiled a new agency website to provide more information and improved tools for consumers. Soon, the commissioner plans on printing a new consumer’s guide to health insurance to help Montanans understand their options and rights.

Consumer Story

The commissioner’s office helped two first-time parents when their newborn was ill and had to stay in the neonatal intensive care unit for an extended period of time. Although the couple was in contact with their insurance plan administrator several times during the baby’s first month, plan representatives never told the parents that, under Montana law, they needed to enroll their baby in their health plan during the first 31 days of the baby’s life. The parents accrued more than $85,000 in claims during this period. When they received a bill for these claims, the couple called the commissioner’s office, and a counselor intervened on their behalf, enrolling their baby in coverage and getting the plan to pay for the treatment that had already been provided.

Sources

• Montana State Auditor, Office of Consumer Information and Insurance Oversight, “Affordable Care Act-Consumer Assistance Program Grants” application submitted on September 10, 2010.
• Email exchange between Elaine Saly, Families USA, and Lucas Hamilton, Communications Director, Montana Commissioner of Securities and Insurance, June 21, 2011.
• Cindy Uken, “Baucus Defends Efforts on Health Care Reform Despite Critics,” Billings Gazette, March 31, 2011.
• Montana Commissioner of Securities and Insurance program website, http://www.csi.mt.gov.

PDF of this profile is available.