Filed Under:Markets, Employee Benefits

Producers: California not exchange paradise

Gina Macaluso takes calls for Covered California. (AP photo/Rich Pedroncelli)
Gina Macaluso takes calls for Covered California. (AP photo/Rich Pedroncelli)

At first glance, the Covered California exchange enrollment system seems to be functioning better -- and more transparently -- than the federal exchanges' HealthCare.gov enrollment site.

The California exchange site has managed to bring in about 179,000 coverage applications since enrollment opened to the public Oct. 1.

But agents and brokers in California warn against assuming that Covered California is working the way it ought to work.

Problems with the California enrollment system include a faulty provider directory, continuing delays with agent certification, continuing delays with final plan approvals, and software bugs.

Before the Patient Protection and Affordable Care Act (PPACA) exchange program came along, health plans were not always quick to make individual health plan provider directories available at point of sale. Consumers often had to call their favorite doctors and hospitals to make sure the providers were in network. But consumers generally knew they were dealing with large, well-established carriers with big provider networks.

Today, the carriers selling "qualified health plans" (QHPs) through Covered California are holding premiums down by using new, narrow provider networks. In some cases, providers may not know whether they're in those provider networks. Looking at a QHP's online provider directory may be the only practical way to find out which providers are in a network without filing a claim.

Managers of Covered California added a provider directory to great fanfare shortly after the enrollment site launch, then uncovered directory system errors, including inaccurate profiles of doctors and hospitals.

Covered California took down the directory component of its site for maintenance. At press time, the directory was still not routinely available.

Neil Cosby, director of sales at Warner Pacific Insurance Services, said in an interview that the persistence of a huge backlog of agents awaiting certification as exchange agents is another dire enrollment system problem.

To get certified, health agents must take an eight-hour class in person, then take a four-hour online class and an online test. Currently, the delays between these steps can last as long as a week or two.

Cosby, who teaches certification courses on behalf of Covered California, said exchange managers are working to fix the problems, but thousands of agents who have completed the certification process are still waiting to be integrated into the Covered California system.

Alison Gordon, a self-employed health broker in California, said the rollout of the certification process for brokers has been an abomination.

“The class I was a part of was not even taught by a broker," Gordon said. "The instructor knew nothing about health. It wasn’t the case for all classes I hear, but it was in mine.”

Meanwhile, the agents who are certified may find that they lack the details they need to recommend plans to consumers.

The California Department of Insurance, the agency responsible for approving QHP prices and benefits, has failed to issue final approvals.

Kathy Hope, a Huntington Beach broker, said the planning of the enrollment program has been ridiculous. 

“All I’ve been doing is schmoozing with clients hoping they will come back to me,” Hope said.

Gordon said only applicants who have low incomes and can qualify for subsidies are getting through the application process. But Covered California isn’t passing the information from the completed applications along to carriers, and she wonders if that's because the carriers themselves lack the final certifications they need to sell coverage through the exchange.  

“The stats released are bogus," Gordon said. "When they say they got 36,000 calls in one week, it’s because the website isn’t up and working properly.”

Producers also see many site errors.

After agents and brokers enter the required information, they often receive error messages preventing them from actually using the online portal. The producers then have to send consumers links consumers can use to download paper applications.

“I had a client try to enroll without me and was getting the same error messages,” Hope said.  “It’s 2013 and people are being asked to fill out applications by hand. That site is too complicated.”

Finally, some producers still wonder whether Covered California managers are simply trying to crowd them out of the exchange plan market.

Both Hope and Gordon said they believe that Covered California is discouraging consumer use of agents and brokers. Instead, the producers said, exchange managers are encouraging consumers to use "enrollment counselors" who have gone through minimal training and are not required to advise customers, just enroll them in plans.

“They recommend use of enrollment counselors and are discriminating against agents who know more,” Hope said. “It’s maddening.”

In response, Covered California Spokesman Larry Hicks emphasized how much Covered California values agents, saying agents represent one of the key channels for providing insurance for uninsured Californians.

The exchange already has 3,200 agents certified and has about 19,000 more agents in the certification pipeline. Once they're all certified, they will greatly outnumber enrollment counselors, Hicks said. 

“I apologize for the frustration felt by the agent community in regards to the pace of the certification process and the glitches to our site, but we are working incredibly hard to fix it,” Hicks said. “There is no intent to discourage agents.”

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