As if employee benefit brokers and advisers in California haven’t had enough uphill battles trying to preserve their standing along the changing HIX landscape, some of them also now have to worry about being paid for helping enroll more than 500,000 residents in the state-run public exchange. But at least one industry insider believes it’s much ado about nothing.

Although 12,600 certified insurance agents are credited with as much as 40% of individual enrollment in Covered California’s first year, as The Los Angeles Times reports, some have waited months to be paid thousands of dollars in commissions owed for SHOP-related business and Medi-Cal, which is the state’s Medicaid program for low-income residents. That number isn’t very significant, however. A deeper concern appears to be that they’re also still encountering marathon phone delays when attempting to resolve simple issues.

Concern is mounting that insurance agents could lose their motivation to sign up more HIX enrollees, and as a result, impede the exchange’s momentum. As part of the HIX’s $95 million marketing effort, California residents are encouraged to find a local agent, which is now easier than the first enrollment thanks to a revamped website with a handy ZIP code search.

Peter Lee, executive director of Covered California, hopes SHOP payments will be made sometime this month. He was contrite about unpaid commissions, telling the newspaper “we think people will need more in-person help this time, and we have folks ready to serve.”

Course correction

A recent report to Covered California’s board revealed that unpaid commissions to agents for SHOP enrollments date back to June. In addition, 2,200 agents are still waiting on $2 million for Medi-Cal enrollments, whose payments aren’t expected to trickle in until next month. Any fees agents earn for individual-exchange enrollments are paid directly by participating insurance carriers.

Covered California has taken steps to correct these, and other, problems — nearly doubling the number of call-center staffers since April and setting up a dedicated line for agents to call. With more than 1.2 million HIX enrollees needing to renew their 2014 policies and efforts under way to sign up another 500,000 residents by mid-February, a busy enrollment season is expected.

While payment delays are frustrating, the dustup may be overblown. The unpaid bills are really “a nonissue,” opines Sam Smith, an insurance broker in Encino and immediate past president of the California Association of Health Underwriters, who says only a small percentage of agents are affected. “It’s nobody’s fault. It happened. They’re cleaning it up.”

Another positive development worth noting is that the SHOP exchange is up to industry standards. “You can submit a case to the SHOP exchange now, and they’ve got it underwritten and to the carriers in four days,” he says.

He’s also sanguine that Covered California is relying more heavily on the agent community this year and “giving us at least some of our due for the job that we’ve performed.” One time challenge, though, is finding a way to fit in this work alongside simultaneous Medicare enrollments, according to Smith.


What concerns him, however, is the current shape of the individual exchange. “I think the biggest frustration that we feel, and I hear from agents all the time, is we’re used to working in an environment where we’ve built relationships with our carriers over the years that if there’s a problem, I know who to call, and I can get it fixed,” Smith reports.

“When it comes to Covered California, it is this generic monolith, where you call in, and you might be number 152 in the queue, and just about the time you’re getting close, they disconnect you or they say, ‘I’m sorry, our call volume is overwhelming right now. Please call again later.’ Click. They have got to take the exchange and get it up to industry standards. And unfortunately, the way they’ve designed the process of open enrollment is everybody is in the funnel at the exact same time.”

And time is money, as the saying goes, but it may be hard for some industry practitioners to calculate all the uncompensated hours they’ve devoted to troubleshooting HIX issues.

Consider the experience of Michael Grodsky, a certified insurance agent for Covered California who’s based in Los Angeles. He has called as many as 30 times to get terminated HIX plans reinstated for some of his clients.

“There’s no accountability with any problem that’s ever on there,” he observes. “I was on hold for 1 hour and 15 minutes this morning. All you do is get some rep who says, ‘I’ll write a trouble ticket and send it to the help desk,’ and then you never hear from them again on it. So it’s been a nightmare dealing with Covered California.”

Since November 1, Grodsky has been unable to help any new people enroll in Covered California because of a technical glitch that doesn’t allow him to accept any online requests to delegate him as a certified insurance agent for the HIX.

Fortunately for Grodsky, he has just one client whose employee population enrolled in the SHOP exchange because of the business tax credit, which is available to groups with fewer than 25 employees earning less than an average of $50,000 salary per year. But he’s also still waiting to be paid for Medi-Cal enrollments for the current plan year and, of course, there’s the issue of all those hours he has had to put in to help correct enrollment glitches.

As a result of the ongoing hassles he has encountered, Grodsky decided not to pursue any new business with Covered California clients because it has become too labor intensive and cost prohibitive. He’s stretched to the limit and would rather leave that work to navigators.

Bruce Shutan is a Los Angeles-based freelance writer.

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