Agents and Brokers Left Out Of Healthcare Marketplace: Assisters Survey
There was a survey that was taken of all of the groups that assisted consumers during the first health insurance open enrollment period under the Affordable Care Act or ACA. The only group that was left out were health insurance agents and brokers. The results of the survey were presented on C-span on August 5th 2014, under the title “Health Insurance Navigators and Brokers”. I found the discussion to be both enlightening and disappointing.
The first person to speak was Jennifer Tolbert from Kaiser Family Foundation. She said many interesting things but the thing that really caught my attention was when she said that many Consumer Assisters were wary of working with brokers because they receive commissions for the products they sell. It’s true we receive commissions when a client chooses to purchase an insurance product using our services but this in no way makes us unethical. The majority of insurance agents are truly in the business to help people. Just as a waiter receives tips commissions are just another form of payment and in most cases it does not affect how we do our job or dictate the products we offer. In many cases especially with exchange business we have been working without compensation for several months. Although commissions have begun to come in there are many agents who have given up on fighting for uncompensated work. Instead of being wary of health insurance agents speak to them you may be surprised at what you learn.
The next person to speak was Karen Pollitz Former HHS Deputy Assistant Secretary For Health Legislation under the Clinton Administration 1993- 1997. She stated that due to technical difficulties they could not document the roll of insurance agents and brokers therefore they could not be included in the survey. I’m not a very technologically savvy person but there are services that can be used to conduct a generic survey such as Jot Form or Survey Monkey. There are forums where they can easily find insurance agents such as LinkedIn or Insurance Forum where they could post a link to their survey. So the excuse for not polling health insurance agents on their experience seems more of a lack of effort than a problem due to technology.
Karen Pollitz also mentioned two other issues that were of concern to consumer assisters. One was the time it took to sign a client up for a health insurance plan. On average 64% of those surveyed said it took 1-2 hours, 2% said it took 4 hours or longer. Most of the time was spent creating an account, collecting household and income information, and in enrolling and picking out a plan. One thing that was left out is if the consumer lacked an email address we had to at times take the extra time to help them create an email account which was required if they chose to apply electronically. The last thing she mentioned that stood out to me was that they think it should be a requirement for insurers who participate in the Marketplace to have a dedicated customer assistance hotline for the Assister Programs. I believe most agents and brokers would agree with this and that the same hotline should be offered to the insurance agents as well. This suggestion should also apply to the Federal Exchange, which will beat waiting on the consumer customer assistance line for an hour or more to solve a simple problem.
The next speaker was Jody Ray from the University of South Florida Tampa Health and Florida Covering Kids & Families Program Director. She mentioned that the roll of Navigators is to educate and do outreach work as well as assist with enrolling consumers in a health insurance plan. She also mentioned that in Florida they require all of their navigators to be fingerprinted, registered, and background checked. For me that dispels a lot of the belief that none of the navigators have to pass a background check. What was not made clear is does this apply to all states.
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Jody Ray was followed by Lisa Stein from Seedco (a navigator entity) Vice President of Work and Family Supporters. She worked with two state based exchanges in Maryland and New York and in two states on the Federal Exchange in Georgia and Tennessee. She mentioned that on the state based exchanges the navigators and assisters’ had access to the backend of the exchange so they could see what was happening with an application when there were problems. This was not the case with the Federal Exchange. She also stated that on the state based exchanges they had regular direct contact with the state based leadership and received answers in real time. On the Federal Exchange they had no direct contact with the exchange leadership. When there was a problem the information had to travel several different channels before it reached the navigators and assisters working in the call centers. This was the same issue that the agents dealt with on the Federal Exchange. I personally worked with the leadership in the state of Maryland on a few of my difficult cases this year. Despite the challenges they did a great job. The dedicated agent and assisters hotline and the dedicated email assistance they gave us was a big plus. They even made a great effort to reconnect agents with their clients by providing us with Broker of Record forms, which they forwarded to the carriers on our behalf. This is a sign to show that they really valued the agents who worked on their behalf. So far I cannot say the same for the Federal Exchange.
Last but not least my favorite speaker of the day was Jessica Waltman from the National Association of Health Underwriters (NAHU) Senior Vice President of Government Affairs. She really stuck up for the agents. Out of all of the speakers she was the only one who did a little research on behalf of the agents and brokers. She mentioned that according to a study by the Urban Institute about half of the people who enrolled used assisters. Out of all of the assister groups that consumers used, the insurance agents received the highest rate for customer satisfaction at 83.9%. She also estimated that nationwide about 100,000 agents participated in the exchanges. So that shows it’s not hard to find or gather data.
Jessica made some really great points on behalf of insurance agents and brokers that are rarely if emphasized on the news or by exchange officials. One, when you choose to work with and agent it will not cost you extra money although in our training materials it does give agents the option to charge a small fee to recoup the cost of shipping documents to our clients if the choose to receive a hardcopy by mail. Most agents do not charge for this. Second agents do not receive grants or any other type of payment from the government. When they assist a client to enroll in a plan their National Producer Number (NPN) should be recorded on the application. When the carrier receives the application the agent receives a small fee, which can be as low as $15 per month if the client pays for their policy. If the client fails to pay the agent essentially worked for free.
Next she laid out the benefits of working with an agent. First the client receives year round service. The agents can help you with claims, questions about your bill, issues with renewals, or if your membership cards that never arrive. They can also help you decide if your health plan is still a good fit for you. A navigator or an assister cannot preform these services.
Following this she talked about how the insurance industry is highly regulated. All insurance agents must be licensed in every state where they do business. Every two years they must complete a minimum number of Continuing Education Credits to keep their license in force. (She said every year but it’s really bi-annually) Insurance agents must carrier Errors and Omissions Malpractice Insurance (E&O). This is a protection for the agent, the insurance carriers and the consumer. Next she mentioned that insurance agents are also legally and financially responsible for the advice they give. In my opinion these are all good reasons to choose to work with an agent or broker. One interesting thing she mentioned is that these laws do not apply to other assister groups because they were not around when these laws were passed.
After that she discussed several issues that insurance agents had to deal with while working on the exchanges. One was the issue of the agents NPN numbers being dropped from the clients application with no easy way to fix the problem. She stated that this is a liability and a consumer protection issue since there should be a record kept of all assisters who are involved in transactions with consumers. In the world of E&O liability, lack of documentation could spell trouble for agents. It’s funny how people in high places are not accountable for these things.
Another issue that came up is when a consumer assister formed a partnership with an insurance agent to better serve their clients. The application only had a space for one ID number to be recorded. This meant that one of the persons who participated in assisting the client would not have their number recorded on the application. This may explain why when an agent called into the call center for assistance with a client’s application, the NPN number was deleted from the application. It happened to me multiple times with the same client three times in less than 24 hours.
Next she mentioned the need for a backend portal on the federal exchange for year round case management. This should function similarly to portals that are used for off the exchange. I know this would help agents to keep track of their business in a more effective way.
The last suggestions were to have a complete list of certified agents and brokers on the Healthcare.gov website so assisters or consumers who want to work with an agent can easily find them. Have a dedicated hotline for agents to call to resolve problems with consumers. Finally to have an improvement in the direct enrollment mechanism for web brokers.
During the final Q&A session there was an issue that was brought up about how navigators and assisters could not follow up with consumers who needed assistance with their policies or problems with the carriers once the policies were issued. Another great suggestion from Jessica Waltman was to partner with agents who have the authority to retain client information in order to follow up with them and give them assistance year round. According to the other panelist navigators and assisters are not authorized to maintain personal information from consumers.
The fact that many of the things mentioned in the discussion are still only suggestions makes me wonder how ready is the federal exchange for the next open enrollment season. Call center wait times are still around 20 minutes depending on when you call. Many agents are still chasing payments from last year’s open enrollment. What this year has in store for insurance agents and brokers remains to be seen.