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Health Insurance & Affordable Care Act

White House Moves to Ease Insurance Fraud Fears

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Most of the states restricting their roles, including Oklahoma, Ohio and Indiana, have defaulted to the federal government to run their exchange websites and are doing no education or marketing about new coverage options.

Obama administration officials  sought Wednesday to reassure consumers that navigators will not be collecting medical records or asking detailed questions about their health because beginning Jan. 1, that will have no bearing on whether they can get coverage or how much they will pay.

The new anti-fraud initiatives include letting people report suspected scams through the marketplace’s call center and to the Federal Trade Commission through the healthcare.gov website.

The federal government is also setting up a “rapid response” system to deal with any security breaches and putting together tip sheets to advise consumers about how to protect themselves.

Impact Of State Restrictions

Experts say it’s premature to say how big an impact the state restrictions on navigators might have -- or how aggressively the laws will be enforced. Missouri passed a law that requires navigators to pass an exam and pay a licensing fee. But state regulators have since said that the 20 hours of required federal training will be accepted in lieu of state training and an exam, and have also limited the licensing fee to $25.

“Our law looks really bad, but we are hoping it will not have a very big impact,” said Lisa D’Souza, a health law and policy fellow at St. Louis University.

She said she worries most about a provision barring navigators from giving advice about health plan benefits even though federal rules require them to help consumers understand that benefits vary. “It seems to be a complete contradiction,” D’Souza said.

A Texas law requires regulators to get involved only if navigators draw complaints; otherwise, no new rules are expected in the first year of open enrollment.

In addition to prohibiting navigators from helping consumers compare benefits, Oklahoma’s insurance commissioner said navigators cannot help people “complete or sign applications for insurance,” or “initiate an inquiry about a person’s existing coverage,” or “discuss the terms of  a proposed contract of insurance with a prospective policyholder.”

Wed, Sep 18 2013

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