The recent survey of more than 800 members of the National Association of Insurance and Financial Advisors (NAIFA) found that an insurance agent helps his or her clients resolve an average of 223 health insurance claims per year. Agents make an average 3.1 calls to health insurance companies for each claim. Assuming the 800 polled agents are a representative sample, this means that overall, insurance agents spend 76,800,000 hours per year placing 138,500,000 calls to help clients with claims.
These figures are meant to illustrate how important insurance agents are. Federal regulators will soon decide whether to classify agent commissions as “administrative” expenses under health care reform, which some experts say could eliminate the profession altogether.
But while the survey successfully proves that agents play a vital role in helping consumers deal with their insurance companies, it also “confirms the extraordinary expense and inefficiency of the current system,” say [PDF] a group of consumer advocates:
The huge number of requests for assistance, multiple agent calls, and tens of millions of agent hours agents spend on claims indicate something is seriously wrong with the health insurance system…
Getting a claim paid should be straightforward with clear rules that are readily understandable to consumers. Consumers, agents and insurance companies themselves should not have to spend hundreds of millions of hours each year on claims issues. Claim appeals should be straightforward, efficient, and effective. Premium dollars could be better spent paying for care or reducing premium costs.
If agents are in fact calling insurers more than 138 million times a year so that consumers get the coverage they contracted for, the problems that plague the health insurance system are even more serious than is commonly recognized.