Sonya Sellmeyer

By Sonya Sellmeyer, Consumer Advocacy Officer for the Iowa Insurance Division

(Des Moines, Iowa) – According to the Kaiser Family Foundation in 2021, only 1% of all denied health insurance claims were appealed to their health insurance plan.  If you believe the healthcare services you received should have been covered under your health plan, you have a right to an appeal. An explanation of benefits (EOB) is issued by the health plan as a summary of the benefits payment towards a claim and is not a bill.  If a claim is denied, a code explains the reason for the denial.  A claim may be denied for an error, lack of information, out-of-network provider, no prior approval for a service or procedure, or the health plan does not provide the benefit.  If you disagree with the health plan’s determination, review the EOB for the appeal rights information.

There are two types of appeal rights.  An internal appeal is a request to the health plan to review their original decision.  You have 180 days after the EOB to file an internal appeal.  For further guidance on filing an appeal with your health plan, call the customer service number on your insurance card.  The health plan may require a completed appeal form, or letter with supporting information.  If the denial is based on the lack of a medical reason, the healthcare provider may be able to assist by writing a letter or providing additional health information to support the claim. The health plan must render a decision on the appeal within 30 days.  If a delay in receiving medical care could jeopardize the individual’s life, health, or the ability to regain maximum function, you or your provider may be able to request an expedited internal appeal with the health plan.

The second type of appeal is an external review, or the opportunity for an independent review of an adverse determination. You may be eligible for an external review after all internal appeals have been exhausted, and the denial is based on medical necessity, appropriateness, health care setting, level of care, or the effectiveness of the health care service of treatment. There may also be a right to external review if the claim was denied as “investigational or experimental.”  An external review must be filed with the Iowa Insurance Division within 4 months of the date of receipt of the final adverse claim determination notice.  The decision of the independent review organization is binding upon the health plan. Should you disagree with the independent review organization, you have a right to a judicial review in Iowa District Court within 15 business days of the issuance of the decision by the independent review organization.

Always contact your health plan to ensure a provider is in-network, services are covered, and to obtain preauthorizations, including those for dental services, as required by the policy.  Taking these steps will ensure health care services are paid for by the health plan according to the policy.

(Stuart, Iowa) – No injuries were reported after a passenger car struck a set of dual tires that came off a semi, west of Stuart. The crash happened at around 9:50-a.m. on Interstate 80 westbound near mile-marker 94. The incident also reportedly started a ditch fire. The car was totaled in the collision. The westbound lane was said to be partially blocked at the 94 mile marker.

Additional details are currently not available.

(Outer space) – If …as predicted…the skies are clear between Friday night and Saturday morning, and you don’t mind staying up late or getting up early, there’s a good chance you’ll see the 2023 Orionid meteor shower. The celestial event will be visible in eastern Nebraska and western Iowa.

Clear skies are expected for the Omaha area, with the hours between midnight and dawn being the best to spot the Orionids. There will be a waxing crescent moon on Friday evening, which will bring more illumination to the night sky. According to the website Earthsky.org, the Orionids radiate from a point near the upraised club of the constellation Orion the Hunter. The bright star near the radiant point is the reddish Betelgeuse.

Image from Theplanets.org.

The Orionids are produced from Halley’s Comet’s particles on its inbound leg. They are moving in one direction, we are moving in nearly the opposite direction, and the combined speeds produce fast-moving meteors. But we also encounter its particles from its outbound leg when it’s leaving the inner solar system. We reach that point in early May. They produce the Eta Aquariids meteor shower. So this comet generates two meteor showers.

Halley’s Comet was last here in 1986 and will return in 2061. But the Orionids never go away, they’re here every October.

(Omaha, NE – KETV) The Douglas County (Nebraska) Sheriff’s Office is finished with its investigation except for the final toxicology report for the crash that killed a 24-year-old Iowa woman in September. According to investigators, Abby Olberding, of Omaha, and formerly of Carroll, Iowa, died on Sept. 13 when a Jeep crossed the center line and hit her Impala, sending it into a ditch near 267th and West Center Road. The other driver is recovering from her injuries and is in stable condition.

According to court documents, the driver of the Jeep was not properly restrained at the time of the crash. Authorities pronounced Olberding dead at the scene and said the other driver was ejected through a glass roof, where she had a broken pelvis, among other injuries.

The Douglas County Attorney’s Office is waiting for the final toxicology report, at which time the DCSO will present its findings from the investigation. The attorney’s office will then determine whether charges will be made.

(Springfield, VA) – October marks the 25th National Prescription Drug Take Back Day. The DEA says it is committed to Americans’ safety and health. As such, they encourage you to remove unneeded medications from your home to prevent drug misuse and opioid addiction from ever starting.

Take Back Day is your chance to rid your medicine cabinet of unneeded and unwanted medications.

Participating drop-off sites will be open from 10 a.m. to 2 p.m. on October 28. Collection sites are located around the country and will be collecting:

• Tablets
• Capsules
• Patches
• Other solid forms of prescription drugs

(Red Oak, Iowa) – Red Oak Mayor Shawnna Silvius has been awarded the Certified Elected Municipal Official (CEMO) designation in 2023. The program was established by the Iowa League of Cities as a way to recognize elected officials who commit to continuing their professional development while in office. The recognition program allows attendees to build towards the CEMO designation while receiving meaningful, informative and useful information on topics that expand the elected official’s knowledge and capabilities. Participation in the program is fully voluntary.

Red Oak Mayor Shawna Silvius

2023 Certified Elected Municipal Officials
Grace Garrett | Mayor, Atlantic
Elaine Otte | Council Member, Atlantic
Rylie Pflughaupt | Council Member, Vinton
Shawnna Silvius | Mayor, Red Oak
H. Lee Sisco | Council Member, Atlantic

“Those achieving the CEMO designation spend many hours, often on weekends and evenings, attending workshops and conferences on a wide variety of municipal government topics,” said Alan Kemp, Executive Director of the Iowa League of Cities. “This is a significant commitment to local government and I commend these individuals for their dedication to become more effective municipal officials.” The CEMO designations were presented at the Iowa League of Cities Annual Conference & Exhibit in Cedar Rapids on September 22.

Additionally, Mayor Silvius was elected to the Iowa League of Cities Executive Board at its Annual Business Meeting on September 20, also held in conjunction with the Annual Conference & Exhibit. The League’s Executive Board is responsible for adopting policies to provide direction to the League, adopting the annual operating budget, establishing membership fees and providing direction to the organization.

The Board consists of 14 board director positions and five officer positions: president, president‐elect and three past presidents. All of these positions must be filled by current city officials who represent cities of various populations and geographic locations. Mayor Silvius was also appointed to the Iowa Mayor’s Association Executive Committee. She is one of 7 mayors elected to this committee in which she represents 17 Southwest Iowa communities.

(Radio Iowa) – Many Iowa communities are struggling to find first responders to fill vacant positions, especially firefighters and police officers. Leaders in Le Mars are considering a change in residency requirements in hopes of attracting more law officers. Police Chief Kevin Vande Vegte says his officers now have to live within ten miles of Le Mars Police Headquarters, and they’re looking to push that out to 35 miles.  “We need to be competitive with our workforce,” Vande Vegte says. “I think the 10-mile requirement is really too constrictive with regards to recruitment. We currently have an opening at the police department and we haven’t had a huge success in drawing in applicants.”

Vande Vegte says this policy change would give potential police officers many more options for places to live. “This is just one part of a retention and recruitment objective,” the chief says. “To extend the residency to 35 miles, I do hope that that might draw in more applicants and in the long run, help with retention as well.”

Vande Vegte says Le Mars is facing stiff competition for potential recruits. The Le Mars City Council will hold a public hearing on the residency requirements on November 7th.

(Harlan, Iowa) – The Shelby County Sheriff’s Office says four people were among the dozen people arrested in the County over the past 2 1/2 weeks. On Oct. 4th, 28-year-old Trevor Michael Brock, of Manilla, IA was arrested following a traffic stop on Road M47. Brock was transported to the Shelby County Jail and charged with Possession of Controlled Substance 3rd or Subsequent Offense, Possession of Controlled Substance Marijuana 3rd of Subsequent Offense, Keeping Premises of Vehicle for Controlled Substance, Possession of Drug Paraphernalia, Driving while Barred, Fraudulent Use of Registration, and Open Container. And, 23-year-old Preston Max Russell, of Boone, IA was Oct. 4th arrested following a traffic stop on Highway 59. Russell was transported to the Shelby County Jail and charged with Possession of Drug Paraphernalia, Unlawful Possession of Prescription Drugs, Open Container, and Speed.

On Oct. 10th, 54-year-old Sarah Jolen Finney, of Harlan, was arrested following a call for service in the 1100 block of Highway 44. Finney was transported to the Shelby County Jail and charged with OWI 1st, Unlawful Possession of Prescription Drug, Driving while License Suspended, Open Container, and Violation of Conditions of Restricted License. On the 13th, 27-year-old Joshua Michael Harlston, of Denison, was arrested following a traffic stop in the 900 block of Highway 59. Harlston was transported to the Shelby County Jail and charged with Possession of Controlled Substance Marijuana 2nd Offense and Keeping Premises or Vehicle for Controlled Substance.

Others arrested by Shelby County Deputies include:

21-year-old Marshall Adam Eggerss, of Panama, who was arrested Oct. 1st following a traffic stop on Hwy 59. Eggerss was transported to the Shelby County Jail and charged with OWI 1st.

There were two separate arrests in Shelby County on Oct. 8th: 36-year-old Erica Ann Horn, of Earling, was arrested following a call for service in the 600 block of 1700th St. Horn was transported to the Shelby County Jail and charged with Domestic Abuse Assault; and, 61-year-old William Joseph Daeges, of Harlan, was arrested following a call for service in the 800 block of Hill St. Daeges was transported to the Shelby County Jail and charged with Trespass.

Three  people were arrested on Oct. 9th in Shelby County: 21-year-old Jayden Wesley Dean Kohl, of Council Bluffs, was arrested on an active Shelby County Warrant for Domestic Abuse Assault. Kohl was transported to the Shelby County Jail; 22-year-old Ethan Michael Leinen, of Portsmouth, was arrested following a traffic stop on Chatburn Ave. in Harlan.  Leinen was transported to the Shelby County Jail and charged with Driving while Barred; and, 42-year-old Carl Francis Martin, of Harlan, was arrested following a call for service in the area of Park St and 12th St. Martin was transported to the Shelby County Jail and charged with Assault.

On Oct. 11th, 34-year-old Simon Buombiey Jacob, of Harlan, was arrested following a call for service in the 500 block of 12th St in Harlan. Jacob was transported to the Shelby County Jail and charged with Violation of No Contact Order and Domestic Abuse Assault; And, 23-year-old Nyagach Dech Chigach, of Harlan, was arrested following a call for service in the 500 block of 12th St., in Harlan. Chigach was transported to the Shelby County Jail and charged with Violation of No Contact Order.

(Atlantic, Iowa) – October is Disability Employment Awareness month. Atlantic Mayor Grace Garrett, Wednesday night, signed a proclamation to that effect during the City Council’s meeting. The proclamation she read (in-part) said…

“The State of Iowa,” she said “believes that long-term investment in rehabilitative workforce programs to help Iowans with disabilities find successful pathways, must remain a priority for years to come.”

Rehna Lensch and Ellen Sokolowski, with Iowa Vocational Rehabilitation Service in Atlantic, were present for the reading of the proclamation. The Vocational Rehabilitation Service office is located in the strip mall just east of the Iowa Western Community College Campus in Atlantic.

In other business, the Atlantic City Council passed a resolution making appointments to the Parks and Recreation Advisory Commission. The commission replaces the former Parks and Recreation Board. It consists of three people living within Atlantic City limits, two Cass County residents, and one non-voting high school student. The appointments, effective January 1^st, include Kevin Ferguson (2-year term), Dolly Bergmann (2-year term), Shirley Jensen (1-year term), Ali Pieken (1-year term), and Mary Strong (1-year term).

Councilman Pat McCurdy…

Mayor Garrett added….

The Council also approved an order to allow the Atlantic Elks Lodge to install a flagpole in the right-of-way abutting 411 Walnut Street. And, they approved an order to shift future fireworks budgets from the Fourth of July to Labor Day, due to the success of the larger, “Bash at the Ballfields event,” that occurred over Labor Day weekend. The 2023 4^th of July Celebration was postponed until Labor Day, due to the weather, but it turns out that the decision to move the celebration brought out many more people, sponsors and vendors, than was possible on the original date.

Urbandale, Iowa (KCCI) – A school resource officer found a loaded handgun in a student’s backpack Wednesday at Urbandale High School. In a statement, Urbandale Community School District officials said two students who were suspected of vaping were taken to the high school office. “One of the student’s behavior escalated quickly while in the administrator’s office,” the statement said, which led administrators to call in the school resource officer. The SRO searched that student’s backpack, in which the officer found the loaded handgun.

The district says it will follow board policy for disciplining the student. According to the school’s handbook, students found on campus with a firearm could be subject to expulsion. Urbandale police have not said if the student will face charges.