California individual and family plan health insurance carriers have been combating fraudulent enrollment for open and special enrollment periods. Many of the health insurance companies have placed additional requirements on applicants to verify California residency. Unfortunately, enrollments through Covered California, which have virtually no verification of special enrollment eligibility, continue to be a source of high-cost claims from fraudulent enrollments.
With the constant erosion of the commission structures to agents for enrolling consumers into health plans in California, many agents have expressed their desire to stop assisting individuals and families with enrollment into Covered California health insurance. There has been renewed talk of allowing agents to charge a consultation fee to make up for the dwindling commissions they earn from the health plans and insurance companies. However, if agents want to make a decent return for enrolling consumers into health plans they need to provide the service so many of them advertise. We need to move from order-takers to consumer advocates, and we need fair compensation for our services.
Consumers receive letters from Covered California stating that their estimated income doesn’t match with their most recent federal tax return. This has led many consumers to assume that Covered California can actually view a taxpayer’s federal return. Covered California can’t see a consumer’s federal tax return unless they send it to them to verify their income.
Covered California is not very health insurance agent friendly when it comes to managing an agent’s book of business. Agents seem to be the last to know when Covered California or Medi-Cal makes changes to a client’s account and either strips their premium assistance or dumps them into Medi-Cal. Covered California has developed book of business and conditional eligibility reports for an agent’s clients enrolled in health plans through Covered California.
For independent health insurance agents, such as me, who don’t have access to an already established secure network through a large agency, we have to be more diligent in securing all the different parts of the internet communication puzzle.
Medi-Cal advocate Beth Capell smeared the reputation of all health insurance agents by insinuating that agents enroll Medi-Cal eligible children in private plans just for the commissions they derive from those enrollments. Ms. Capell is assuming, incorrectly, that all health agents put money above the best interest of their clients. It’s unclear where Ms. Capell’s animus towards health agents springs from when thousands of agents have assisted tens of thousands of families with enrollment in Covered California and Medi-Cal health plans.
Over the course of two different letters to U.S. Department of Health and Human Services (HHS) Secretary Burwell, the Executive Director of Covered California, Peter Lee, outlined the benefit of Certified Insurance Agents to their enrollment activities and suggested there should a uniform commission structure for health insurance agents. Mr. Lee’s comments come at a critical time when many health insurance companies are reducing and even eliminating agent commissions.
Anthem Blue Cross, following internal policies to protect agents, prevents their members from selecting their preferred health insurance agent through Covered California. The Blue Cross policy of not recognizing an agent delegation made by a household in their Covered California account prevents the selected agent from properly representing the family members and being compensated for his or her time. The Blue Cross agent of record policy occurs when the Covered California member originally enrolled with another agent or without an agent and the member is considered a house account.
At some point you get tired of dealing with idiots. At some point you need to complain with the full understanding that nothing changes because government bureaucracies and private corporation sucking off a government contract never change. As my phone showed I had been on hold for over four hours with Covered California’s agent support Pinnacle Management, I was able to finish writing the following complaint forms to Covered California.
Covered California Certified Insurance Agents assisted 429,365 individuals for possible enrollment into the expanded ACA Medi-Cal health insurance from January 1, 2014 through July 31st, 2015. The Medi-Cal assistance enrollment figure comes from a Public Records Act Request that I submitted in early October of 2015 to Covered California. As the $58 compensation to agents for Medi-Cal enrollments ceased over the summer I felt it was important to learn the level of agent involvement with funneling Californians in Medi-Cal health plans.