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Officials warn about scam artists for new health law

It’s time for some tire-kicking, and that means you’ll need to look out for lemons.

As the Silver State Health Insurance Exchange goes live Tuesday, the 800,000 or so Nevadans who are uninsured or who buy plans on the individual market will have a virtual shopping center where they can test-drive premiums, copays, deductibles and coverage.

And where there are people giving up personal details and dropping thousands of dollars on an important product, there are scammers lying in wait to take advantage.

“We’re very concerned, now that the exchange is about to go live, that there will be fraudsters who will pick on consumers not educated about what this law means for them,” said Todd Rich, deputy commissioner of the state Division of Insurance.

It’s especially a concern given Nevada’s already-high rate of fraud. A May report from the Federal Trade Commission ranked the state No. 5 for its share of consumers who said they had been defrauded. Nevadans filed more than 15,000 complaints in 2012, including more than 3,000 identity-theft complaints. That was a fraud rate of 559.9 of every 100,000 people, compared with a national average of 430.9.

There are things you can do to protect yourself, and state officials said they’re working to help you out.

Start with how they’re vetting the “navigators,” “exchange enrollment facilitators” and “application counselors” who’ll guide you through the paperwork to buy a plan.

Federal law requires states to have navigators, but those regulations don’t mandate background checks. That wasn’t good enough for the Division of Insurance, which in the spring won approval from state lawmakers to license and certify navigators, enrollment facilitators and application counselors who work for the exchange. With that authority comes the ability to collect fingerprints and do background checks to weed out felons and others with a questionable history. It’s a layer of protection many states lack, Rich said.

“We’ve been a leading state on requiring this level of background check and accountability,” he said.

The division is also working with the state attorney general’s office and other agencies to develop an anti-fraud strategy, Rich said.

Yet, even the best vetting system misses some bad apples. So it’s also up to consumers to be careful.

First, it’s your right to ask any navigator to show a state license or certification information.

Plus, you can ask who the navigator works for. The state insurance exchange has given grants for training and hiring more than 100 navigators in Southern Nevada to seven nonprofits: Inter-tribal Council of Nevada; Know Your Care; the Children’s Cabinet; Consumer Assistance and Resource Enterprise; East Valley Family Services; Latin Chamber of Commerce Community Foundation; and Richard Allen Community Outreach. You might find navigators in places ranging from hospitals to insurance brokerages, but they should be working for one of those groups.

Also, be leery of the hard sell. You shouldn’t be getting unsolicited phone calls peddling coverage, nor should you let anyone convince you that you could go to jail for not having insurance, Rich said.

If someone tells you their premium offer is good only for a couple of weeks, so you have to buy today, that’s another red flag. Premiums quoted after Tuesday won’t change until 2014’s renewal season. Look out for people who ask you for your bank account numbers or demand a check up front. Neither is needed to get coverage.

In general, remember you have plenty of time: The initial enrollment period runs through Dec. 15.

“There’s no hurry to sign up immediately. No one should be pressured to give information they feel uncomfortable with right away,” said Adam Plain, insurance regulation liaison with the Division of Insurance. “If consumers are approached with a scenario that doesn’t seem right, consumers need to understand they have a right to walk away.”

Rich had one more tip for seniors in particular: Division officials said they’re particularly concerned about scammers defrauding older Nevadans, who might be out of the loop on Obamacare because it doesn’t really apply to them.

If you’re older than 65, you’re Medicare-eligible and shouldn’t be buying coverage through the exchange. Don’t fall for any sales pitch that says otherwise.

You can avoid navigators altogether by signing up directly through the state exchange’s website, www.nevada­healthlink.com, or by calling 855-768-5465. You can also consult a state-licensed insurance broker.

The exchange said it expects to get 40 percent of its enrollment through its website and call center, and another 20 percent from brokers. The rest will come from navigators.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com. Follow @J_Robison1 on Twitter.

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