Update on DOI property insurance market data call

In response to Bulletin 25-02, the Department has received submissions from most companies, though a few companies were granted brief extensions due to extenuating circumstances and those submissions should be completed soon.

Once all data is submitted, the Department will need time to analyze and verify it for accuracy. This process will involve both Department staff and external partners.

The Department is eager to complete the analysis and we are aiming to do so within 30 days. However, that timeline depends on the quality of the data received and whether any issues arise during the review process.

The goal is to have the data and analysis finalized by August, though it is possible the process may take longer. We appreciate the cooperation of the companies in this effort.

April 22, 2025 news release: "Idaho Department of Insurance issues property insurance market data call"

Consumer assistance leads to successful claim resolution

The DOI recently helped resolve a complaint from a consumer who believed he had purchased insurance coverage through a UPS Store for a valuable clock he shipped for repairs. Unfortunately, the clock was damaged in transit, prompting the consumer to file a claim.

Despite providing the requested photos of the damage, the consumer did not receive a response for over a month. After he contacted the Department, staff reached out to the insurance producer handling UPS claims. As a result, the consumer received payment for the damages.

Grateful for the Department’s assistance, he sent a heartfelt thank-you note expressing his appreciation.

Senior Health Insurance Benefits Advisors (SHIBA) success stories

Helping a beneficiary avoid a $52,000 hospital bill

A beneficiary contacted our office after receiving a $52,000 bill following a hospital stay. Although she was admitted under Medicare Part B observation, doctors had intended to switch her to inpatient status prior to surgery. Due to a hospital error, the change to admitted under Medicare Part A was never processed, which led to improper billing and left her Medigap coverage unused.

Our office worked with the hospital’s billing supervisor, the Director of Patient Services, and the hospital social worker to resolve the issue. After reviewing the case, the hospital acknowledged the mistake, reversed the charges, and billed her Medigap plan appropriately. The beneficiary was overjoyed and deeply grateful for our assistance.

Reversing cancer treatment denials in North Idaho

Our office assisted a family struggling with coverage denials from a Medicare Advantage Prescription Drug (MAPD) plan that no longer operates in North Idaho. The complainant was undergoing cancer treatment at a local facility and had received approval for 12 treatments—yet the insurer later denied 3 of them.

Over the course of 18 months, the provider repeatedly rebilled and appealed the decision without success. After our office intervened and worked directly with the insurance company, the denials were reversed and payment was issued. Both the patient and the treatment provider expressed sincere gratitude for our 

Two individuals sentenced for felony insurance fraud

Elisa Hernandez (Caldwell) was convicted of one felony count of insurance fraud following an investigation by the Department’s Fraud Unit. Canyon County District Judge Davis VanderVelde sentenced Hernandez on May 28, 2025, to a total of 7.5 years in prison—1.5 years fixed and 6 years indeterminate. She was also ordered to pay $7,260 in restitution to the insurer.

Canyon County woman sentenced for insurance fraud

Jill Marie Buratto of Nampa, Idaho pleaded guilty to insurance fraud, a felony, for falsely reporting and accounting for fiduciary and/or trust funds and diverting those funds to her own use. On June 18, 2025, she was sentenced to the maximum of five years’ probation, 60 hours of community service, a $2,000 fine, and ordered to pay restitution.

Nampa bail agent sentenced for committing insurance fraud

The DOI encourages anyone who suspects insurance fraud to report it through its website or call its fraud hotline at 1-866-939-7226.

Pharmacy Benefit Manager (PBM) oversight update

The DOI continues its oversight of Pharmacy Benefit Managers (PBMs), with several ongoing efforts including complaint investigation and compliance monitoring. A temporary administrative assistant is currently supporting the review and investigation of complaints, as well as maintaining records related to compliance reporting and administrative actions. An existing administrative assistant is also providing support with weekly reporting.

Complaints Update

To date, the DOI has received 43 complaints from pharmacies regarding PBMs. Of these, 36 remain open or pending, while 7 have been closed. Complaints may include multiple issues, with the most common being related to Maximum Allowable Cost (MAC) appeals and dispensing fees. The DOI Consumer Affairs team is also assisting the PBM Examiner with investigating reported concerns.

PBM Reporting Compliance

PBMs are required to submit data by January 1 and April 1 annually. While most entities have complied, not all have met the submission requirements. The DOI is currently verifying the accuracy of submitted data and is has taken legal action against those in noncompliance. The next reporting deadline is July 1, 2025.

Dispensing Fee Survey

A dispensing fee survey, conducted by Myers and Stauffer LC, went live on April 18, 2025. As of June 13, the response rate stood at 21.0%. Pharmacies were required to return completed forms by May 29, but extensions were granted to those needing additional time. The survey results will help the Department evaluate the reasonableness of current dispensing fees.

Submit inquiries on DOI website

PBM complaint form for pharmacies - Complete a separate form for each PBM if there are multiple complaints

For questions and information contact PBM@doi.idaho.gov 

Producer Licensing to offer Spanish language testing option

Our Producer Licensing team is working closely with our exam provider, Pearson Vue, to offer licensing exams in Spanish. The new language option is expected to be available beginning August 1, 2025.

Safety first: Behind the scenes at record-setting Boise concert

On June 24, more than 37,000 fans gathered at Albertsons Stadium for the highly anticipated Post Malone and Jelly Roll concert. Ensuring the safety of every attendee was a top priority, thanks to the coordinated efforts of a dedicated team of deputies and the Idaho State Fire Marshal.

The team spent the entire day inspecting food trucks, egress integrity, emergency apparatus access, flame effects and pyrotechnics. They also worked closely with crowd managers, providing detailed emergency response plans to ensure quick action if needed.

Boise State’s strong commitment to safety, along with the support from Anderson Construction Company—currently overseeing the North Endzone project—helped make the event a smooth success. Their combined efforts enabled the entire crowd to safely exit the stadium within just 20 minutes of the concert's finale. 

The State Fire Marshal’s Office extends sincere thanks to everyone involved in making this event both safe and memorable. Here's to many more large-scale events hosted with the same level of excellence and care.