Insurance agents struggling with state's new health exchange



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Posted on June 4, 2014 at 11:20 PM

Updated Thursday, Jun 5 at 12:48 PM

For months we've been hearing about consumers' struggles with the state's new health exchange program. Jesse Jones explains that they're not alone in the fight -- even some of the people paid to work the system are having a hard time.

Martha Gant is an insurance agent who's used to helping others but now she's the one in need.

Gant owns Cascade Insurance Pros in Wenatchee.  Her business has exploded since she started signing customers up for the Affordable Care Act.  But Gant says this system is a real pain.  Why?  She claims her business hasn't been paid in full for enrollments.

“Right now I'm waiting on 393 payments and at $17 dollars apiece, that's a lot of money!” exclaimed Gant.

Here's how this works.  Gant is a broker for Premera.  She has to use the state's health exchange to enroll new clients.  Then Premera is supposed to send her a commission check every month for each client.  What happens next seems to be a disappearing act.

“What's happening as near as I can tell is that when the client goes over to Premera there's like a black hole.  They all the sudden fall off of my list as being the agent," Gant said.

Since she's not listed as the agent, Premera doesn't know to pay her.  Gant reported the issue to the state and Premera but says they simply blame each other.

“It's real difficult to be positive when we feel like we're sitting out there on an island,” said Gant.

So she asked me to get involved.  I contacted Premera and spokesman Eric Erling says Martha's issue isn't new.  He says the problem is not with them but tied to the exchange.

“What's really important there is that flow of information after the member has signed up, after payment is made to the health plan finder and then getting accurate information into our system so that we can tie it all together and make the right payment to the right person,” explained Erling.

Erling said the insurer has been paying Gant, but is still working on an accounting of her file.  He adds the only way Gant or any other agent gets paid is based on the information provided by the state.

“When there are errors in the information we receive from the health plan finder, we are not able to reconcile the data appropriately. So we're not able to link the premium payment to the member and then be able to pay the commission,” said Erling.

As for the State, they are still trying to figure out what happened in Gant's case.   Michael Marchand with the Washington Health Benefit Exchange admits the system isn't perfect and knows the issues need to be fixed quickly.

“We want to make sure that people get paid for the work that they're doing. We've been looking into these cases individual by individual and agent by agent to make sure that everything is up to speed and getting corrected,” said Marchand.

As for Gant's issue, since we've spoken to Premera and the State, some corrections have been made and Gant is supposed to get a commission check this week.