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PPACA exchange may transfer callers to brokers

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Back before Oct. 1, 2013, when public health insurance exchange systems came to life (or failed to come to life), some exchange builders seemed to go out of their way to spit in brokers’ eyes.

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Since then, managers of most of the state-based Patient Protection and Affordable Care Act (PPACA) exchanges that are still state-run have done what they could to reach out to brokers.

Managers of Maryland’s PPACA exchange, the Maryland Health Connection, want to take outreach a step further: Starting with the 2016 individual coverage open enrollment period, which is set to run from Nov. 1, 2015, through Jan. 31, 2016, they want to transfer many consumers who call the exchange call center directly to authorized brokers.

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Having call center customer service representatives make warm transfers of consumers to brokers should shorten the reps’ caller handle time, give consumers access to expert advice on coverage options, and give the brokers easy access to a stream of eager, pre-qualified leads, according to a broker pilot presentation prepared by Michele Eberle, the Maryland exchange operations director.

Eberle talked about the pilot program Tuesday, during an exchange board meeting.

For more details about the pilot program, taken from a written version of Eberle’s presentation included in a board meeting slidedeck, read on.


1. Broker prep

In the system envisioned by Maryland exchange managers, brokers will supply their own headsets and install call center phone software on their own computers.

To take calls from exchange callers, they’ll log into a special queue in a phone system.

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2. Call center rep maze running

A call center rep will get a caller through the complicated PPACA coverage eligibility screening process.

The rep will determine if the caller appears to be eligible for Medicaid or other government health programs, such as the Children’s Health Insurance Plan (CHIP) program.

The rep will also see if the caller qualified for PPACA premium tax credit subsidies, or PPACA cost-sharing reduction subsidies.

Once a rep knows that a caller is eligible to buy exchange coverage, and with what, if any, PPACA subsidies, the rep will offer to transfer the caller to a broker.

The broker and the rep will perform a brief call-transfer “tango.”

If the tango goes well, the rep will hang up, and the broker will take over and handle enrollment services.

See also: 10 PPACA exchanges with upmarket appeal 


3. Rollout plans

Maryland exchange managers have already tested the call-transfer system and found that it can work.

They want to conduct a small real-world test, with just two brokers, on Sept. 15 and Sept. 16. The goal for those two days is for the brokers to complete 12 enrollment transactions involving consumers eligible for special enrollment periods.

If the two-broker test goes well, the exchange will conduct a pilot test program, with 25 brokers, from Nov. 1 through Jan. 31.

If that 25-broker test goes well, the exchange will then open the broker assistance transfer program to all authorized brokers in the state.

The exchange will focus on working with brokers who understand the exchange program well and have offices close enough to the Maryland Health Connection for exchange workers to go to the brokers’ officers to help resolve computer problems.

Eventually, if the broker transfer program goes well, the exchange would also give call center reps the ability to offer callers warm transfers to health system navigators, public program caseworkers, officials who take consumer complaints, and administrators who understand the Small Business Health Options Program (SHOP) system.

See also: Why don’t brokers love PPACA small-group exchange programs?


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