Close Close
Popular Financial Topics Discover relevant content from across the suite of ALM legal publications From the Industry More content from ThinkAdvisor and select sponsors Investment Advisor Issue Gallery Read digital editions of Investment Advisor Magazine Tax Facts Get clear, current, and reliable answers to pressing tax questions
Luminaries Awards

Life Health > Health Insurance > Health Insurance

Agents Often Help With Health Claims: NAIFA

Your article was successfully shared with the contacts you provided.

Agents are an important contact when consumers have problems in filing a health insurance claim, according to a new survey by the National Association of Insurance and Financial Advisors (NAIFA).

NAIFA undertook the survey at the request of the National Association of Insurance Commissioners (NAIC).

In a presentation at the fall meeting of the NAIC, held in Orlando, Fla., Diane Boyle, NAIFA vice president, federal government relations, told the commissioners that “agents play a critical role in servicing clients with local, personalized and cost-effective ways that deliver value. And the carriers know that.”

According to the survey, agents say they receive an average of 223 requests each year from clients seeking help filing claims.

Of the agents surveyed, 69% said each claims issue requires them to contact the insurance company at least twice on behalf of the client, while 11% said each claims issue requires six or more calls.

Additionally, 82% said they contact the client at least twice per problem claim to follow up, provide updates or request additional information.

The survey was based on a poll of 806 NAIFA members.

“In the wake of our country’s massive healthcare overhaul, the role of the agent is more important than ever,” Terry Headley, NAIFA president, commented.

He called agents “highly trained professionals who handle many of the complex issues in healthcare–including claims assistance–that would otherwise result in headaches for consumers, not to mention add to the workload of state insurance departments if consumers had nowhere else to turn.”

Agents also serve an educational role when it comes to the claims process, Headley noted. Of survey respondents, 71% said they provide service calls to clients to explain the claims process and answer questions.

In addition, licensed health insurance specialists design benefit plans, explain how individuals can coordinate available public and private benefits, and solve problems that may occur once coverage is in place, Headley said.

Ultimately, however, NAIC in a plenary meeting Thursday decided it did not have the authority to honor agents’ request to exempt them from the restrictions imposed on administrative costs in health insurance through the medical loss ratio (MLR) formula set forth in the Patient Protection and Affordable Care Act.

The decision was made, despite the fact that 15 state commissioners sought to exempt the agents from the MLR through a so-called “pass-through” mechanism.

The formula as crafted by the NAIC now goes to the federal Department of Health and Human Services for final action.


© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.