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Life Health > Health Insurance > Health Insurance

Carriers, watchdogs debate exchange regs

By Allison Bell

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The controversy over PPACA has spilled into the retail level.

Carriers and consumer groups now are fighting over federal regulation of customer service reps. The debate includes federal standards for Web-based brokers, health fair booth staffers and others who might try to help consumers understand the Patient Protection and Affordable Care Act exchange system.

Representatives shared their thoughts in comments on draft PPACA regulations the Centers for Medicare & Medicaid Services released in June.

Anthony Mader of WellPoint Inc. welcomed a provision in the draft regs that describes how carrier customer service reps can help consumers enroll directly through a state’s exchange program.

Mader said CMS should be clearer about training and other standards for the doctors, nurses and others who will talk to consumers about PPACA at public forums.

“The community-based forums are incredibly important sources of information for many consumers,” Mader said. 

Steven Kelmar, an Aetna Inc. executive, said his company likes the idea that carrier reps can help consumers but hopes the exchange website will be the primary enrollment mechanism.

“Enrollment that occurs directly through insurer websites should be a secondary priority and supplementary option,” Kelmar said.

Rob Restuccia, executive director of Community Catalyst, a consumer group, said his group worries carrier customer reps might not know much about the other plans on the exchange, or about the exchange system as a whole.

If CMS lets customer service reps enroll consumers directly, they should have to give the consumers extra information, including information about how to reach exchange navigators, or ombudsmen, who can provide unbiased consumer help, Restuccia said.

Restuccia and Scott Giesler, general counsel for eHealth Inc., a Web-based health insurance broker, disagreed about how CMS should regulate any Web brokers that sell exchange coverage.

Community Catalyst would prefer that Web brokers be required to get all exchange plan pricing and rating information, and at least compel them to display it all in a manner consistent with what’s on the exchange website, Restuccia said.

“Web brokers must be held accountable for the accuracy and timeliness of information,” Restuccia said.

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