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Life Health > Health Insurance > Health Insurance

Let's make our own case

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What the Affordable Care Act (ACA) exchange system makes evident is the erosion of the agent’s value to consumers of insurance in the eyes of the government, insurers and consumers themselves.

Had the developers of the exchange better appreciated the value of the agent, the Centers for Medicare & Medicaid Services (CMS) and its parent, the U.S. Department of Health and Human Services (HHS), would have given brokers the same direct access to enrollees as they have for navigators, insurers and others.

In other words, when exchange enrollees visit the marketplace website, at, they should be able to communicate directly with independent brokers in real time.

This could still happen, but before it does, a case for having every exchange enrollee be given the option to establish a relationship with an agent of record has to be made.

It’s a discussion worth having.

I do not, however, expect insurers to help make the case to the government for us.

Every exchange enrollee should have an agent of record because agents often help resolve problems that occur after enrollment, and only such an agent, not a customer service rep, can take on the role of being an insured person’s advocate.

A recent news story appears to have insurers viewing social media monitoring as a solution to dealing with members’ unresolved issues.

There was no mention in the article of how insurers are empowering their agents. Had insurers wanted their exchange enrollees to have agents of record, the mechanics to do so would have already been worked out.

I do not expect consumers to make the case for us either.

It appears that neither agents nor insurers are educating the insured well enough about how agents can be of great service to them long after they have enrolled in a health plan.

A recent survey of District of Columbia residents found that respondents were leery of working with agents through their exchange.

No wonder agents appear to be a CMS/HHS footnote in the initial effort to enroll millions of people through the exchanges.

If agents don’t know how to make their own case for their special relevancy to the exchange, this indicates to me agents are either too stymied or clueless about how their profession is changing now that the ACA is unfolding.

Like a self-serving grocery checkout kiosk, the exchange was designed to eliminate the need for agents at the point of sale. Yet, it doesn’t have to go this way.

What should be happening?

An analogy can be made to accountable care organizations and their emphasis on quality of care. For agents, we can call it quality of service. Agents need to recognize how their service role will keep them relevant to consumers in the ACA insurance world.

This means the reason for giving bonuses to agents needs to change.

Bonuses should be given not for increasing sales, but for providing better after-sale service.

When an insured person tweets to the world about how she was screwed over by her insurance company, you have to wonder whether this person had an agent to call on.

If agents were to be compensated for helping a distressed insured client, that would go a long way toward helping consumers appreciate the value of enrolling through an agent.

More to the point: The way to get CMS/HHS thinking favorably toward agents of record for exchange enrollees is to get insurance carriers to move toward making changes to our bonus culture.

Exchange enrollees should have as their default option an agent of record, but this won’t happen while agents conduct business as usual.

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