Archive for April 2012

Why Navigators Won’t Benefit the Health Insurance Exchanges

Many health care experts are apprehensive about consumers getting contradictory or unreliable recommendations about their health care insurance options from an unlicensed navigator when the exchanges begin in 2014.

According to the Department of Health and Human Services (HHS) a navigator must:

1.) Conduct public education activities to raise awareness about qualified health plans.

2.) Provide fair and impartial information about enrollment in qualified health plans, premium tax credits and cost-sharing reductions

3.) Assist consumers in choosing qualified health plans

4.) Provide referrals to an applicable consumer assistance program or ombudsman in the case of grievances, complaints or questions regarding health plans

5.) Provide information in a manner that is culturally and linguistically appropriate

According to the PPACA (Patient Protection and Affordable Care Act), “Navigators will likely be comprised of representatives of trade associations, business associations, and other community-based organizations; they also may be brokers. However, PPACA prohibits navigators from accepting remuneration from an insurer. The Secretary of Health and Human Services (HHS) is charged with establishing standards for navigators.”

To explain where I am headed I have a few questions for you to consider:

1.)  If you were arrested and charged with murder would you prefer to have a public defender who was called just hours before your arraignment?  Or would you want the best legal representation you could get?

2.) If you went to the doctor and they said you have a brain tumor and you need surgery, would you rely on a nurse practitioner at Urgent Care or would you want the best brain surgeon you could find?

The point is that in every case you will want the best representative you can get because it is critical that you have an expert in their field so you can obtain the best advice possible.  Let’s look at what might be in store for you if the exchanges go live in 2014.

Navigators (your representative) will likely be comprised of representatives of trade associations, business associations, and other community-based organizations..” according to the PPACA.

If you select an insurance company while you are healthy and then you have a catastrophic health problem you better have chosen wisely because the insurance company may be deciding if you live or die based on what they cover and how they pay the claims.   When you need treatment for a life threatening illness you may not have time to argue about the treatment you are receiving.   The point here is that someone qualified needs to stand up for people who have coverage and then need treatment.  People who are ill need somebody who knows insurance coverage and has the courage to fight for them.  Do you believe that will be your pastor?  Do you believe it might be your local union representative?

When you need help to get your insurance explained to you, to have somebody stand up for you, to know your family will be considered, you will need an agent with knowledge and courage.  And that agent will need to get paid for his services.  However, PPACA prohibits navigators from accepting remuneration from an insurer.  That means you must pay them directly yourself.

Ask the question: What should my insurance agent do for me? 

The answer should be to represent you when you have a claim.  If all they did for you was sell you insurance then you have the wrong agent.  You bought insurance to protect you from large financial losses, or in the case of medical or disability coverage, to protect your life!

It sounds attractive when somebody tells you medical care will not cost you as much and those terrible insurance companies will not be able to charge you so much anymore because of the healthcare reform law.  But that is a misconception.  If the cost of insurance you buy is not adequate enough to cover the claims you might have it does not matter who provides the coverage, the insurance company will not have the money to pay the claim when you need them to.  Your life, and your family’s life,  may be the real price you pay.

You cannot let politicians tell you they know the answer because for generations they have proven they do not know what to do.  We are at this impasse for healthcare now because politicians persuaded the public about the benefits of universal healthcare coverage for all Americans (including free preventive coverage) and the public listened.  However, as usual they did not talk about the cost or how to do it best.

Giving away something for free will always guarantee a big crowd.  It also guarantees a financial loss if it is continued.  If you combine basically free health insurance with a total lack of qualified advice, you can only expect the system to eventually go broke and for you to not get your medical bills paid unless you pay them yourself.

I do not espouse either political party in this discussion as they both have shown a remarkable lack of expertise on the subject.  I do encourage you to use your mind and do some critical listening and then some critical thinking.

What are your thoughts?  Do you think navigators will benefit or hinder the health exchanges?





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