GAO audit finds brokers misleading consumers on pre-existing conditions
In one instance, a sales representative told a health insurance shopper that Obamacare plans were no longer in effect.
Many individuals shopping for a health insurance plan on the ACA exchanges turn to brokers to help wade through the options and pick the plan that’s right for them. However, a recent audit by the Government Accountability Office suggests that those brokers aren’t always acting in the consumer’s best interest.
As reported by The Hill, GAO employees posing as consumers shopping for health insurance conducted 31 phone calls with brokers. While the results showed an appropriate outcome in 21 of the calls, brokers appeared to intentionally mislead consumers in eight instances, and in two instances, the representatives were inconsistent but did not appear to be intentionally deceptive.
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“While the results of our covert tests cannot be generalized to all sales representatives, any particular state, or the PPACA-exempt health care industry at large, they illustrate how sales representatives in some cases engaged in potentially deceptive marketing practices that could lead a consumer to make poor decisions,” the report noted.
In one instance, a representative told a caller that Obamacare plans were no longer in effect. In another, the caller was told they were getting a comprehensive plan but was instead sold two limited-benefit plans. Sales representatives stand to earn a greater commission on such plans as an alternative to ACA-compliant options.
According to the report, “During the call, we repeatedly informed the sales representative that we had diabetes and had recently been seeking treatment for the condition. However, the application filled out by the sales representative on our behalf, which we later obtained, stated that we had not been treated for or diagnosed with diabetes for the past five years.”
The investigation was conducted at the request of Senate Democrats, who suspected that companies selling limited-benefit products that were not compliant with ACA requirements were misrepresenting their plans.
“We need to make sure that these companies and brokers are held accountable, and that consumers understand their options, when I say held accountable— these people should be in jail prosecuted and be in jail,” said Sen. Bob Casey (D-Pa).
The investigation included brokers and sales representatives in Alabama, Florida, Kansas, Pennsylvania and Wyoming, all of which allow limited-benefit plan sales. While the Department of Health and Human Services said it will look into the findings of the report, it noted that it only has jurisdiction over brokers registered to sell on Healthcare.gov.
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