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Consumers need us

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The New York Health Benefit Exchange for individuals and small businesses opens for enrollment Oct. 1, with the coverage to take effect Jan. 1, 2014.

We need to help consumers and business owners in the state understand this message: An experienced, licensed health insurance agent is the best resource for helping them understand the new health insurance options.

Now is the time for agents and their friends to make sure that agents have the compensation and standing they need to participate in the exchange system, to support a smooth transition to a health care system that will be better for all.

Most people don’t want to leave decisions about their health care to a new state functionary with only limited training.

The professional health insurance agent is not a call center worker with a modicum of training and a FAQ screen with set answers.

Agents have spent years learning about the state’s health insurance market, and years developing relationships with individual consumers and business owners. Those trusted relationships will be even more important when the exchanges open.

The agents who serve exchange users will also have to obtain many hours of formal training to serve individual exchange users, and even more hours of training to help business owners use the state’s Small Business Health Options Program (SHOP) exchange.

Just a few months ago, for example, the Metro New York Association of Health Underwriters provided four exchange-related continuing education courses for more than 200 agents who attended the association’s annual convention. The agents learned about the carriers’ new products and received both state and federal legislative updates.

An exchange-certified agent can explain the differences between the bronze, silver, gold and platinum plans; help consumers determine whether they are eligible for subsidies; and help consumers find the most affordable plans that meet their coverage needs.

Many of the new exchange plans will have relatively small provider networks.

Consumers may find that some of the names on the exchange carrier list are unfamiliar.

Insurance agents can give consumers more information about the carriers and also explore all other available options, whether those options are exchange plans or other types of plans, such as government health programs or union plans.

Agents can also help consumers look in a plan provider directory and make sure a preferred doctor is in the network.

Once consumers sign up for coverage, agents can follow up with the carriers, to make sure enrollment forms and claims have been processed properly.

In New Hyde Park, N.Y., for example, agent Brian Bodner helped a bookkeeper settle an unpaid claim that totaled $600. The woman was upset and unable to sleep because the bill had gone to collections, so Brian sat down with her and organized all of the paperwork. Together, they began making calls. They were able to get the claims resubmitted and processed by the carrier. As a result, the lab notified the collection agency that the bill was settled.

The New Hyde Park story illustrates another important point: That health care insurance can never be managed by smartphones alone, no matter how smart the phones may be.

Advocacy is essential to avoiding the many pitfalls in our complex system of private insurance and governmental bureaucracy.

A professional agent has a long-term interest in keeping a consumer healthy and satisfied.

It will be the agent who will be there to help a consumer with a claim appeal, a billing error, a policy coverage question, and so on, all the way to resolution.

Agents know what it takes to make health care reform succeed in New York.

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