New Survey Shows Insurance Agents Spend Substantial Time Assisting Clients with Healthcare Claims Issues

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Survey Backs Legislators’ Call to HHS to Amend New Consumer Web Portal with Information on Agents’ Services

It’s shortsighted of the government to expect consumers will receive a high level of service from a computer database without giving them access to the expertise and personalized attention of an agent.

A new survey by the National Association of Insurance and Financial Advisors reveals that agents are an important point of contact when consumers have difficulty filing a health insurance claim.

According to the poll of 807 NAIFA members who serve health insurance clients, agents say they receive an average of 223 requests each year from clients seeking help filing claims. More than two-thirds of the agents (69%) said that each claims issue requires them to contact the insurance company at least twice on behalf of the client, while 11% said each claims issue requires six or more calls. Additionally, 82% said they contact the client at least twice per problem claim to follow up, provide updates or request additional information.

“In the wake of our country's massive healthcare overhaul, the role of the agent is more important than ever,” said NAIFA President Terry Headley, LUTCF, LIC, FSS. “Agents are highly trained professionals who handle many of the complex issues in healthcare -- including claims assistance -- that would otherwise result in headaches for consumers, not to mention add to the workload of state insurance departments if consumers had nowhere else to turn.”

NAIFA conducted the survey at the request of the National Association of Insurance Commissioners, which consists of state insurance regulators from all U.S. states and territories as well as the District of Columbia. NAIFA will present the results to the commissioners at the NAIC Fall 2010 National Meeting, October 18 - 21, 2010, in Orlando.

The survey results carry added relevance in light of the Obama administration’s healthcare reform and the launch of the Department of Health and Human Services’ new healthcare web portal, , which provides a listing of insurance companies, along with a breakdown of their various plans and pricing information, but offers no information on the services registered agents provided to consumers.

“It’s shortsighted of the government to expect consumers will receive a high level of service from a computer database without giving them access to the expertise and personalized attention of an agent,” Headley said.

Agents offer a range of expertise, Headley said, such as helping a small business comply with complicated state and federal obligations, including COBRA, ARRA, CHIP, ongoing CMS reporting, HIPAA, and Mental Health Parity requirements. In addition, licensed health insurance specialists design benefit plans, explain how individuals can coordinate available public and private benefits, and solve problems that may occur once coverage is in place.

Agents also serve an educational role when it comes to the claims process. More than 71% of survey respondents said they provide service calls to clients to explain the claims process and answer questions.

Earlier this summer, Rep. Charlie Melancon (D-LA) stated his opinion on the role of an agent in a letter to HHS Secretary Kathleen Sebelius signed by 24 other members of Congress: “The portal and planned call center will provide individuals and small businesses with basic coverages and price information in a centralized location, but will not provide the personal service and plan policy knowledge that distinguishes independent and state licensed health insurance agents and brokers,” the letter states. “These professionals provide individuals and small businesses with information and advice about all products in the marketplace, so that consumers can adequately compare the value and appropriateness of every health insurance option available to them.”

Rep. Dina Titus of Nevada also sent a letter to HHS.

For more on the role of the agent, visit the NAIFA Blog.

About NAIFA:
NAIFA comprises more than 700 state and local associations representing the interests of approximately 200,000 agents and their associates nationwide. NAIFA members focus their practices on one or more of the following: life insurance and annuities, health insurance and employee benefits, multiline, and financial advising and investments. The Association’s mission is to advocate for a positive legislative and regulatory environment, enhance business and professional skills, and promote the ethical conduct of its members.


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