Marketplace Navigators Changing Clients Plans

[MaryDallas]

What a horror story! I have gone through my files no less than 6 times each to make sure everything is accurate; not only on my end/the marketplace/the insurance company. This is all 'very' laborious ... for no big bucks either. And I do care about income and do not do this pro bono. It's not like it's 'fun'. It is a lot of responsibility for people for those that do care about people.

 

[FLM2]

call the CMS regional offices.. I had a case last year that took 10 months to clear up

to spare you several pages of gory, familiar, and boring details... Long and short - I had a client that had to be submitted/escalated several times because information on the application kept falling off (half the family) by the time it got to the carrier which rendered subsidies incorrect, and premiums incorrect, etc. Started in January and finally got a correct application to the carrier for a June 1... only problem was they cancelled her for non-payment in August; they took the payments she made and applied them to the prior incorrect applications... so she did not have coverage in June when her hubby went in the ICU for several days... good times.

I was able (a few months into it) to determine CMS had not provided guidance on how to "null" an invalid plan so the carrier thought they were owed for plans that were not valid and could not have been accessed and thus were swiping payment. Learned that several hundred people were in the escalation loop for the same thing... the marketplace escalation rep let slip about the CMS regional office oversight.

I tracked down the number for the regional office, reported the problem (had to have the client handle call backs - CMS wouldn't talk to me... ) I was able to get them to investigate, and they got her plan re-instated back to June using the payments already applied, got her meds (family took a ton of them) re-imbursed for having had to pay out of pocket, got her hubby's 60k ICU bill covered for her original 500 deductible/ 750 MOOP... call them... see how fast that gets fixed...

You did a great job but the reality is that all of that time you spent just isn't worth it for the compensation received-an attorney would have probably billed out over $5K to obtain the same result.

While I care about clients getting what they are paying for I have reached the point where I am no longer willing to take anywhere near the responsibility I have in the past for making sure things are correct. Agents are being marginalized by a system that doesn't want us around so why even bother, there is little to be gained by it and very much to lose if things go wrong and the client (or carrier) throws you under the bus.

An example of this is the income documentation for subsidies-I have clients asking me what they should put down on the stuff they send in and all I tell them is 'whatever you put on the application, it's your subsidy, not mine'.

 

[taterpeeler]

You did a great job but the reality is that all of that time you spent just isn't worth it for the compensation received-an attorney would have probably billed out over $5K to obtain the same result.

While I care about clients getting what they are paying for I have reached the point where I am no longer willing to take anywhere near the responsibility I have in the past for making sure things are correct. Agents are being marginalized by a system that doesn't want us around so why even bother, there is little to be gained by it and very much to lose if things go wrong and the client (or carrier) throws you under the bus.

An example of this is the income documentation for subsidies-I have clients asking me what they should put down on the stuff they send in and all I tell them is 'whatever you put on the application, it's your subsidy, not mine'.

I agree 100% w/this statement... I aint you hoochie daddy, I tell you what to do and I expect you to do it...dont do it, your back, not mine.... i will assist a client in paying their bill and sending the docs but i aint your daddy... get a jacked up situation at the ff., i will try to help but after that... well, dunno what to tell ya

 

[scagnt83]

I do and I dont understand why you guys are engaging in marketplace business. It is a double edged sword on multiple levels.

In a way, I would guess that the only reason half of the people on the exchange know whats going on is because they are using an agent who is helping them.

If agents stopped doing marketplace biz, then the public would be screwed (even more) and truly realize what a mess this is.

Of course you guys have kids to feed... which is the opposite side of that sword.

Are there any stats on how many exchange policies used an agent?

 

[Zanetti90]

I do and I dont understand why you guys are engaging in marketplace business. It is a double edged sword on multiple levels.

In a way, I would guess that the only reason half of the people on the exchange know whats going on is because they are using an agent who is helping them.

If agents stopped doing marketplace biz, then the public would be screwed (even more) and truly realize what a mess this is.

Of course you guys have kids to feed... which is the opposite side of that sword.

Are there any stats on how many exchange policies used an agent?

*****

according to Joe Biden 1/3

 

[somarco]

how many exchange policies used an agent?

HHS would be the source. Do you really trust them?

Just a wag, but probably around 30 - 40%. Could be higher if navigators hadn't snaked applicants away.

 

[scagnt83]

HHS would be the source. Do you really trust them?

Just a wag, but probably around 30 - 40%. Could be higher if navigators hadn't snaked applicants away.

Thats a pretty high number considering they can do it all themselves sitting on the couch. If agents just totally pulled out and boycotted the exchange things would be FUBAR for consumers.

When the client calls to ask what happened just tell them to call their Senator...

 

[FLM2]

I do and I dont understand why you guys are engaging in marketplace business. It is a double edged sword on multiple levels.

In a way, I would guess that the only reason half of the people on the exchange know whats going on is because they are using an agent who is helping them.

If agents stopped doing marketplace biz, then the public would be screwed (even more) and truly realize what a mess this is.

Of course you guys have kids to feed... which is the opposite side of that sword.

Are there any stats on how many exchange policies used an agent?

I don't have kids to feed but took on Exchange business as a test for this year and it's by and large failed.

Next year I will limit my exposure and subsidy client base to those who had smooth sailing this year, I have no interest in continuing to help those who make it difficult.

 

[somarco]

As I said, it is just a wag. Not sure you can get a true number. There are a handful of agents (including one that runs a telesales company) that wrote a lot of business.

Then you have folks like eHealth pushing Obamacrack.

The numbers (whatever they are) get cloudy because of applications started by agents that got "lost" in the system along the way with agent NPN's being knocked off the transcript.

Consumers as a whole have lost under Obamacrack. For all the talk about those who could never get or afford coverage there are 20 more that have suffered because of this law.

The goal of providing health insurance for all (which will not be achieved with Obamacrack) took a convoluted and wildly expensive track. The simplest and least costly approach would be to leave the prior system in place and shore it up with Medicaid expansion and a national risk pool.

Of course that would be too easy.

 

[bluediamond]

You did a great job but the reality is that all of that time you spent just isn't worth it for the compensation received-an attorney would have probably billed out over $5K to obtain the same result.

While I care about clients getting what they are paying for I have reached the point where I am no longer willing to take anywhere near the responsibility I have in the past for making sure things are correct. Agents are being marginalized by a system that doesn't want us around so why even bother, there is little to be gained by it and very much to lose if things go wrong and the client (or carrier) throws you under the bus.

An example of this is the income documentation for subsidies-I have clients asking me what they should put down on the stuff they send in and all I tell them is 'whatever you put on the application, it's your subsidy, not mine'.

Amen to that, I tell them what to do then it's up to them, I don't call for them or sit with them while calling mp, once they get their tax credit they are in obama's hand's. And talk about reaching out and touching someone, those hands jerk and slap that person around until they are