- 1,908
I sell the PPO Plan (usually PHCS). I'm not worried about my E&O.
Assurant One deductible Traditional Plan
- Thread starter bluemarlin08
- Start date
I sell the PPO Plan (usually PHCS). I'm not worried about my E&O.
- Thread starter
- #22
- 1,926
Sell it to any individual/couple without small children, who are not on three or more medications.
It is my top selling product. What I sacrifice in commissions,
Sorry, I thought you were responding to my question regarding one ded traditional.
BTW, didn't mean to infere anything regarding your E&O.
It is my top selling product. What I sacrifice in commissions,
Sorry, I thought you were responding to my question regarding one ded traditional.
BTW, didn't mean to infere anything regarding your E&O.
- 307
One Deductible Traditional
One Deductible Traditional
Hey guys, not to be contradictory here but some of you have this incorrect. Yes, the One Deductible Traditional is any doctor, any hospital and claims are paid on a Reasonable and Customary basis. However, if the One Deductible Traditional is selected, there is a shadow network (PHCS) that is used when processing and paying claims.
So, similar to Assurant's STM, the customer can go wherever they like, but if the provider/facility was in PHCS, its good for the carrier and client as the PHCS negotiated discount is still processed. And unlike the One Deductible PPO, there is no out-of-network deductible and 20% coinsurance until the OOP maximum is met.
Now, the question is whether the premium difference is worth it on the One Deductible Traditional in return for not having an out-of-network deductible and additional OOP on OON services.
So in summary, there is a network but its not promoted so as to not confuse the customer and us.
One Deductible Traditional
Hey guys, not to be contradictory here but some of you have this incorrect. Yes, the One Deductible Traditional is any doctor, any hospital and claims are paid on a Reasonable and Customary basis. However, if the One Deductible Traditional is selected, there is a shadow network (PHCS) that is used when processing and paying claims.
So, similar to Assurant's STM, the customer can go wherever they like, but if the provider/facility was in PHCS, its good for the carrier and client as the PHCS negotiated discount is still processed. And unlike the One Deductible PPO, there is no out-of-network deductible and 20% coinsurance until the OOP maximum is met.
Now, the question is whether the premium difference is worth it on the One Deductible Traditional in return for not having an out-of-network deductible and additional OOP on OON services.
So in summary, there is a network but its not promoted so as to not confuse the customer and us.
- Thread starter
- #24
- 1,926
Are you sure about this? I talked with Assurant this morning and that is not what they told me. I hope you are right!
- 307
Blue Marlin,
Assurant Health's agent support line told me the same thing they told you but in practice they're wrong. That's what they are told to say. My information comes from the claims department. Before I posted my last post I called yet again to make sure I was right.
PHCS is the underlying network but the plan is still considered indemnity.
Assurant Health's agent support line told me the same thing they told you but in practice they're wrong. That's what they are told to say. My information comes from the claims department. Before I posted my last post I called yet again to make sure I was right.
PHCS is the underlying network but the plan is still considered indemnity.
So . . . claims are processed under the PHCS pricing scheme, not R&C. Can the provider balance bill?
BX does something similar here with their STM product but they use a different pricing scheme (higher) from their traditional PPO product. So a STM policyholder gets a break but not that much of a break.
Back to One Deductible Traditional, not sure it justifies the 70% or so rate up over the PPO plan.
If you are going to "catch a break" on the billed charges, why not go ahead any buy the PPO plan? Still can't see the logic behind selling the Traditional plan over the PPO.
BX does something similar here with their STM product but they use a different pricing scheme (higher) from their traditional PPO product. So a STM policyholder gets a break but not that much of a break.
Back to One Deductible Traditional, not sure it justifies the 70% or so rate up over the PPO plan.
If you are going to "catch a break" on the billed charges, why not go ahead any buy the PPO plan? Still can't see the logic behind selling the Traditional plan over the PPO.
- 1,908
#2 agrees with #1
- 7,790
Still waiting patiently to find out who "Ned" is. Salpro22 never got his query answered.
- Thread starter
- #30
- 1,926
I'm Ned. I happened to meet somarco in a phone and email exchange and he dropped my name, not that I care. Had a great day today, 6 life applications and 2 HSA and one LTC. Doesn't happen everyday but when it does it is sweet. I think it is time for a much deserved adult beverage while the steaks marinate.
