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How the PPACA exchange program still infuriates agents

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B. Ronnell Nolan is in one of those strange positions that top brokers often find themselves in.

She represents passionate producers who are working themselves into a state of dire unwellness … to sell health insurance for an organization that seems to despise them.

She is president of Health Agents for America (HAFA), a group that has been trying to help producers communicate with the Consumer Information and Insurance Oversight (CCIIO). CCIIO is the arm of the Centers for Medicare & Medicaid Services (CMS) that manages implementation of the Patient Protection and Affordable Care Act (PPACA) commercial health insurance market provisions for CMS, and for CMS’s parent, the U.S. Department of Health and Human Services (HHS).

Before the PPACA public exchange system opened, managers of the state-based exchanges were open about their interest in eliminating agents’ share of the U.S. health care cost pie.

See also: Vermont comp proposal: $15 per person per month

Managers of other state-based exchanges, and the HHS exchange program, seemed to want to build a strong, business-like relationship with producers.

See also: Feds: Our exchanges will work with producers

In late 2013 and early 2014, when the first PPACA major medical open enrollment period started, some of the more arrogant exchanges, including the exchange in Vermont, were brought low by technical problems with enrollment websites. They depended heavily on producers for help with bringing in applications.

This year, a few state-based exchanges have published data suggesting that exchanges may be getting a high percentage of their enrollees through producers.

HHS brought in Kevin Counihan, a highly respected private exchange and Connecticut state-based exchange veteran, to run the exchange program, including oversight of the exchanges HHS runs through the HealthCare.gov system.

HAFA members were hoping Counihan would help improve the exchange-producer relationship.

For a look at what Nolan has seen actually happen this year, during the second PPACA open enrollment period, read on.

Gloomy sky

1. CCIIO still won’t send producers a decent e-mail newsletter.

One of the strangest problems certified HHS exchange agents have is their lack of a legal ability to get the same informative, uncontroversial educational newsletter that CCIIO sends to navigators and other nonprofit exchange helpers.

CCIIO occasionally sends a much skimpier newsletter to agents.

When Nolan asks CCIIO officials about the newsletter gap at public meetings, “they just kind of ignore the question.”

Her sense is that CCIIO workers feel the refusal to send agents a good newsletter comes from the top. 

Call center

2. Some HHS exchange call center reps hang up on agents, or seem to delete producers’ National Producer Number (NPN)from exchange applications for no good reason, and producers have no way to identify which rep caused the problem.

Nolan said she can’t remember hearing many complaints about exchange call center rep hang-ups coming out of states with state-based exchanges.

At the HHS exchanges, some reps say rude things to agents, hang up when they find an agent is on the line helping a client, or even brag about deleting the agent’s NPN from the application file, Nolan said.

Because the reps do not provide an identification code, agents have no good way to file complaints about problems with reps, or to discover whether concerns are the result of bad apples or general training and attitude problems, Nolan said.

Doctor shrugging

3. PPACA rules help plans strand clients. 

Producers work hard to help clients sign up for plans that cover their favorite doctors and any prescriptions they need, Nolan said.

But plans can delete providers from their networks and drugs from their formularies in the middle of the year, after the open enrollment period is over and the enrollees are trapped in the plans, Nolan said.

Maze

4. Having Counihan in the system hasn’t really helped.

Nolan said she went to Washington thinking she could meet with him. That never happened.

She met with Counihan’s aides. They seemed nice. But, at this point, she said, CCIIO really hasn’t made any significant changes in the way it relates to producers, Nolan said.