Agents and Brokers Left Out Of Healthcare Marketplace: Assisters Survey

Health Insurance Marketplace

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.

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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.

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.

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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.

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Comments

I am an agent and I would really like to see a better attitude toward agents this upcoming enrollment. PS. I am still waiting to get paid
I really hate when agents call the marketplace and have the csr's do their job and gemad when we refuse to put their npn number on the application when they should be doing it in the first place! I thought that is what "agents" were supposed to do! My point is unless you are going to split the commission with the csr's that are doing the agent's work in the first place STOP complaining about not getting paid! If you want your commission then do your job!
There is so much misinformation when it comes to agents and brokers. The way the Marketplace is set up has left the agent community caught in the middle of a system we did not ask to be a part of. Our clients also are affected by this. While not all CSR’s are misinformed many are. Many agents have turned to web brokers in an attempt to avoid Healthcare.gov and the Marketplace as much as possible. The fact that some agents do use the Marketplace to do enrollments is when they have no other choice or do not want to pay a fee to use a web broker. When there are issues with an application or when it goes incorrectly to an insurer the insurer does not have the authority to make the needed changes. Depending on the change that needs to be made if it cannot be done through a direct enrollment portal according to CMS instructions agents and brokers need to do a three way call to the Marketplace call center. If the CSR accesses the consumer's application during the call we are instructed to request that the CSR add our NPN to the application. This eliminates issues with the agent being able to assist the consumer when the application reaches the insurer. It’s also your job. Contrary to your erroneous point of view we are doing our job but at the same time following the rules and regulations that have been put on us by the new healthcare laws. We have requested a phone line separate from the call center that serves consumers that can help us solves issues with out contacting the Marketplace directly. This has been done in some states and eliminates the need to call the consumer line. In Maryland we have a broker portal on the exchange and receive updated list if our book of business. Unfortunately CMS made you the middleman. Around November 23, 2015 was the first time agents using the direct enrollment pathway had access to the form on the Marketplace application to add their own NPN directly on the application. In the event that the agent does a three way call with the consumer it would still be your job to add the requested information to the application. After all it’s what you get paid for. Unless you only get paid on a per application basis then following CMS’s explicit instructions should not be an issue for you. If you are paid per application then I understand your frustration. If you are paid by the hour then you should perform the duties required of your position. If you really do not want to be used as a go between then maybe you should ban with other CSR’s and push for a phone line that deals exclusively with agent and broker application issues but until then we will follow the instructions given to us and call the call center when necessary according to CMS instructions. Unlike many people many agents are independent business owners. We get paid for results not for the advice we give. When we produce results that is write an application that brings in a new client for a company we get paid only when the transaction is completed. If we got paid and the consumer withdraws their application many times the agent must give back the money they earned. Our pay is called commission for a reason. No matter what a persons mode of payment is called, salary, tips, wages, fees, or commissions everyone deserves to be paid for their completed work. Some cases are simple but others are more complicated and time consuming especially with having to deal with data matching documents, tax issues and other things that was never part of our job. Not to mention the hour of wasted time being on hold with the Marketplace and the insurers. Just as you get paid for what you do. Agents and brokers also deserve to get paid for work that they have completed. So just as you feel we should do our job you should also do yours even the unpleasant parts that may not seem fair. It’s what we have been doing since the beginning of the ACA.
The sad thing is if you wait to get paid chances are you will not get paid. There was only one company who began to pay without much effort on my part and my client information and status actually appear on my agent portal something many other companies claim is impossible with exchange business. To get paid you need to be proactive. The truth of the matter is we entered into a contract with these companies. With that being said they should have to hold up their end of the bargin. So don't give up the money being held hostage is your.
article after article the agent is put on the back burner compared to an "assisters". Its really amazing an un-lic'd person can sell health insurance to the public. What really sucks is the national ad campaigns that promote the 800# and website but excludes an option on the website to contact a local agent based on your zip code. I have a call tracking# on my yellow page add and 3 months before ObamaCare July, Aug, Sept 2013 I rec'ved 64 calls or about 21 per month. For Oct , Nov and Dec 2013 I rec'ved 2 calls or less than 1 per month. Oct. to April sold 4 policies and 3 were from people frustrated with the "assisters" lack of insurance knowledge on prescriptions. My income has dropped so badly I almost can't afford my $1500 a year in E&O insurance and will have to drop my YP ad too since writing 5-10 policies which pays about $75 - $150 in commissions doesn't pay the $162/mo fee to run the ad. Well I have started a discount dental program at expandinghealthcare.com and for weekend extra money to pay bills starting Epic Paintball Park this spring to fill in the gap of loosing 1/2 my income. I would like to see the amount of insurance brokers who were health lic'd in 2012 vs 2014 and see how many of the missing agents left for other work or on welfare. PS on a side note, I used to write an app and within 48-72 hours have a policy issued in the mail with an effective date of the day I wrote the business. Now its 15 - 45 days the client has to wait and you can't be written up anytime of the year its now a "open enrollment period". Careful voting your rights away.
I had an agent who helped me with a few questions. It took her approximately 15 minutes. It was for a special enrollment. My application had been already completed . I tried to get this agent's NPN number on my account but I would not update my application because it took me 6 months to get my change in circumstances (I lost my job) verified. (At the time she even tried to convince me to give her my login.) The agent later called the marketplace either pretending to be me or saying she had my approval to call on my behalf and said that I wanted my previous insurance cancelled and my new insurance to start right away and to escalate this ...all in an attempt to get her NPN number on the policy. She was successful. I use my health care all the time with appointments and medicines. So far I have spent about 5 hours trying to rectify this issue. Now I may have to pay double for August and then do without health care for at least 30 days with medicines costing $500. I am a consumer. I didn't need a broker. & I never will again. Security on the marketplace is nil. It's scary.
terry I'm sorry for what happened to you. I do not know what state you are in but what I do know is that agents are not suppose to have access to your login credentials. In some states they can help you set up your account but only with a written and signed consent form. On the federal Marketplace an agent cannot access your account without doing a three way call with you on the line to give permission for them to act as your agent. This is limited authority and you decide what access they will have to your account and how long that authority will last. If it was with the Federal exchange and a three way call was not done the representative gave the agent access to your account, the exchange representative would be at fault for not following the proper procedure and the agent would also be in violation for accessing your account without the proper authority. I do agree with you there are too many anonymous hands that have access to consumer accounts. The good thing is at least you know who your agent was. I hope all of your issues have been resolved.
Thanks, Sheron! I've been told that the Marketplace rep has to "physically" cancel authorization once it is given. If the Marketplace rep doesn't remember to do so, the authorization could continue for 14 days... Even though I gave this insurance agent access for one phone call only during a three-way call such as you described. I know it doesn't make sense. I am following up with an FOIA request to pull the phone call recording. I don't especially want to go to the FTC or state Board and possibly lose the agent her license....she has all the information about me any criminal could make use of. but I have to be certain she receives no compensation and her NPN # is removed.
There is so much misinformation when it comes to agents and brokers. The way the Marketplace is set up has left the agent community caught in the middle of a system we did not ask to be a part of. Our clients also are affected by this. While not all CSR’s are misinformed many are. Many agents have turned to web brokers in an attempt to avoid Healthcare.gov and the Marketplace as much as possible. The fact that some agents do use the Marketplace to do enrollments is when they have no other choice or do not want to pay a fee to use a web broker. When there are issues with an application or when it goes incorrectly to an insurer the insurer does not have the authority to make the needed changes. Depending on the change that needs to be made if it cannot be done through a direct enrollment portal according to CMS instructions agents and brokers need to do a three way call to the Marketplace call center. If the CSR accesses the consumer's application during the call we are instructed to request that the CSR add our NPN to the application. This eliminates issues with the agent being able to assist the consumer when the application reaches the insurer. It’s also your job. Contrary to your erroneous point of view we are doing our job but at the same time following the rules and regulations that have been put on us by the new healthcare laws. We have requested a phone line separate from the call center that serves consumers that can help us solves issues with out contacting the Marketplace directly. This has been done in some states and eliminates the need to call the consumer line. In Maryland we have a broker portal on the exchange and receive updated list if our book of business. Unfortunately CMS made you the middleman. Around November 23, 2015 was the first time agents using the direct enrollment pathway had access to the form on the Marketplace application to add their own NPN directly on the application. In the event that the agent does a three way call with the consumer it would still be your job to add the requested information to the application. After all it’s what you get paid for. Unless you only get paid on a per application basis then following CMS’s explicit instructions should not be an issue for you. If you are paid per application then I understand your frustration. If you are paid by the hour then you should perform the duties required of your position. If you really do not want to be used as a go between then maybe you should ban with other CSR’s and push for a phone line that deals exclusively with agent and broker application issues but until then we will follow the instructions given to us and call the call center when necessary according to CMS instructions. Unlike many people many agents are independent business owners. We get paid for results not for the advice we give. When we produce results that is write an application that brings in a new client for a company we get paid only when the transaction is completed. If we got paid and the consumer withdraws their application many times the agent must give back the money they earned. Our pay is called commission for a reason. No matter what a persons mode of payment is called, salary, tips, wages, fees, or commissions everyone deserves to be paid for their completed work. Some cases are simple but others are more complicated and time consuming especially with having to deal with data matching documents, tax issues and other things that was never part of our job. Not to mention the hour of wasted time being on hold with the Marketplace and the insurers. Just as you get paid for what you do. Agents and brokers also deserve to get paid for work that they have completed. So just as you feel we should do our job you should also do yours even the unpleasant parts that may not seem fair. It’s what we have been doing since the beginning of the ACA.
I an a consumer not an agent. The agent called the marketplace and pretended she was me. While during that call she got her NPN number on the app. She also blithley changed the start date of my enrollment without my knowledge or consent causing a firestorm of issues. She also wangled her way onto my dental plan with another company. As a consumer I am staying away from all agents in the future and if I find there are any additional identity theft issues, I will use the transcript of the call she made pretending she was me for further legal action. I don't care about the rights of agents...they don't matter in this case of identity theft.