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.
Anthem Blue Cross not recognizing Covered California delegation
Agents have complained since the inception of Covered California health insurance enrollments that they haven’t been paid for individuals and families they assisted with enrollment into their qualified health plans. The agent of record policies by Anthem Blue Cross and other health insurance companies may be partly to blame for the lack of agent recognition and compensation.
Agent of Record protection
The Agent of Record, sometimes referred to as the Broker of Record, policy has always been a means of protecting the original agent from having his or her book of business from being poached by other agents. The fundamental premise is that the original agent shouldered the initial expense of marketing the health plan and ultimately enrolling the member.
Covered California enrollment requires additional assistance
Unfortunately, with the advent of the health care reform and Covered California, there is a whole new layer of assistance that is needed on the part of an agent to enroll a household in a health plan with premium assistance. Many families have long forgotten the agent who originally assisted them with enrollment. Additionally, some of those original agents may not even be certified with Covered California to help the families, but are nonetheless getting the credit. There are also many agents who aren’t equipped to assist households with Covered California enrollment because of complicated issues with immigration, residency, and family income challenges.
Consumers prevented from changing agents
What has happened is that many individuals and families have sought out other agents to assists them with their Covered California application or renewal. The household will delegate the agent in their Covered California account so the agent can view the application and make any necessary changes. Unfortunately, when this agent delegation is transfer to Anthem Blue Cross, and the family was already in a Blue Cross health plan with a different Agent of Record, Blue Cross ignores the agent delegation.
Agents work for free when not the Agent of Record
The end result is that the newly delegated agent is denied any compensation for his or her efforts to help the household navigate the complex Covered California application. (Agents are paid commissions or enrollment fees by the health plans and insurance companies, not by Covered California for individual and family plans.) The individual or family is also denied having their newly designated agent from representing them at Anthem Blue Cross for any billing issues that might arise. From my perspective, an agent should be as much an enrollment advisor as well as a member advocate before the health plan itself.
Commission reconciliation and Covered California
While many agents are familiar with the Agent of Record conditions, I only stumbled onto it recently. I must admit that matching the commission statement from the health insurance companies to my Covered California clients is low on my list of administrative duties to perform each month, if ever. I happened to have reviewed one of those commission statement documents and realized I wasn’t being paid for families that I had enrolled through Covered California.
Agent of Record change forms being automatically submitted
I completely understood that the Covered California agent delegation did not automatically translate into a carrier’s Agent of Record designation. All of the health plans and insurance companies have slightly different rules when it comes to being designated as the Broker of Record. Since the oversight of the designation was on my part, I didn’t attempt to recapture back commissions. But decided I had to be more proactive to insure that I would be appointed going forward.
Some consumers fight to get agent appointed
This proactive approach meant sending an Agent of Record change form to individuals and families that I have started enrolling into Covered California for the 2016. Both I and one of the families I was working with received a letter from Anthem Blue Cross denying agent delegation based on the fact that the family already had an agent listed for them. My angelic client took it upon herself to contact the insurance agent they had not talked to in years, and who had actually retired, to get his former insurance agency to release the broker designation.
Health insurance and Covered California selections can be time consuming
At least for me, enrolling an individual or family in health insurance through Covered California is not necessarily a ten minute process. I usually spend time researching network providers for the household, reviewing prescription medications against the various drug formularies, performing a rate comparison of the available health plans, reviewing the Covered California application for changes, and I spend time with the family analyzing their household income for the premium tax credit assistance and income tax implications.
Will agents stop servicing new requests for help?
I’ve learned the hard way that my work on behalf of a client who wants me to represent them does not always pay off. Even if I demand that the client delegate me in the Covered California system, the Agent of Record rules may prevent me from being compensated and contacting the health insurance company on behalf of the client. In essence I am working for free which both the health insurance companies and Covered California love. Assistance that I provide to the client is the assistance that neither Covered California nor the health plans have to offer. This reduces their overall expenses for customer service representative time spent with individuals and families trying to navigate the health insurance maze.
The Anthem Blue Cross Agent of Record Designation Administrative Guidelines even forces existing members who had never chosen an agent to remain without agent representation.
On Exchange individual health benefit plans – For new membership with an Original Effective Date of 1/1/14 or after, enrolled on a plan sold through Covered California, Anthem shall recognize as the AOR the agent identified as the AOR in the enrollment information received from Covered California. If no AOR is designated in the enrollment information received from Covered California, Anthem shall have no obligation to recognize any claimed existing agent-client relationship. Under the Agent Agreement and this Guideline, an enrollment will only be considered to be new membership if there has been no prior coverage through Anthem, or if any prior coverage through Anthem has lapsed for a period of three (3) months or greater.
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Anthem Blue Cross reduces expenses by denying assisting agents a commission
The net effect is that Anthem Blue Cross classifies the health plan members who enrolled through Covered California without an agent as a house account. Just because a family chose a Blue Cross plan initially without an agent, they shouldn’t be forced to continue without representation. This is like the IRS telling tax payers that if they never used a tax preparer or CPA that can’t have professional assistance or representation in the future. Neither Covered California nor the health insurance companies provide any analysis of the household income or comparative analysis of available health plans.
Consumers left naked with no representation
How can consumers make an educated and informed decision without some assistance? Is Anthem Blue Cross going to compare the family’s current plan to their competitors? Will Covered California research to see which of the family’s doctors and hospitals are in-network with the various plans being offered in the household’s region? No, No and No. An agent can do this only if he or she is being compensated.
Consumers should have freedom designate any health plan agent
Regardless of how Covered California improves their online enrollment system there will always be a need for enrollment assistance. The Covered California goal of making virtually all enrollments a self-service process will never happen. The Affordable Care Act is too complicated. And yet, Covered California goes out of their way to provide cover to the health insurance companies by allowing them to constantly cut commissions and prevent consumers from designating agent representation through the Agent of Record process.
What is the cost of answering simple questions?
So far I have not had to curtail my assistance to individuals and families seeking my advice on either Covered California enrollment or a health plan selection. I gladly answer all questions regardless of whether I am the delegated agent or the Agent of Record. I work from premise that if I adequately help those who have questions, they will ultimately delegate me as their agent. But I can see a time when I may have to filter out requests for assistance based on whether I can actually be designated as the Agent of Record. I don’t want that day to come.
Will Covered California advocate for agents?
Covered California needs to push the health plans and insurance companies to accept the agent delegation through their online application as the Agent of Record for the respective health plan enrollment. Covered California has a monopoly as the only venue for receiving the premium assistance to lower health insurance premiums. With this monopoly comes the responsibility to protect consumers from unfair health insurance practices that forces families to forgo agent representation based on a policy that is really designed to limit the insurance company’s liability of paying compensation to Covered California Certified Insurance Agents.