Healthnet of CA - Advice Needed

[pipedream]

While I was composing my last post and after I hit "submit", I received the following email from my brother. The information in it puts a clearer light on the situation than I was able to.

Here is what he wrote: "I was away from home, hundreds of miles. I did not have access to my files, and had no other way to get information except from Health Net. I spent 38 minutes on the phone with Health Net, with the main topic being "coverage at UPMC.

I believe that there is a pattern of misinformation. Getting information from HN is like pulling teeth, and I now have several well documented examples of misinformation being offered. Insurance companies are not permitted to "Misrepresent to claimants pertinent facts or insurance policy provisions relating to any coverages at issue" Ca. Insurance Code section 790.03(h). Words have meaning, and they should be required to give accurate information. Detrimental reliance..... at the least.

If their representative is unable to provide correct information, then these issues should be referred to a supervisor. A newly diagnosed cancer victim should not be expected to know that he is likely to get incorrect information from the insurance co, nor be expected to ask carefully crafted questions regarding coverage issues. The information that I sought, is straight forward, and could have been provided quickly and accuratly.

UPMC lowered the cost of the procedure to what Health Net said that it should be.... just as if they were contracted with HN."

 

[Dave020]

Again, is his agent involved in the process?

 

[pipedream]

Again, is his agent involved in the process?

I will find out and let you know.

 

[Dave020]

If he has an agent he needs to put that agent to work to fix this for him. Agents can get a lot done behind the scenes working with the carrier. He really should have worked through his agent before he had this done.

If he bought direct from the carrier and has no agent, then you can now see the disadvantage to saving no money doing that and cutting out a real resource.

 

[somarco]

Agents can get a lot done behind the scenes working with the carrier. He really should have worked through his agent before he had this done.

You spoke volumes in those few words. Some days it seems I spend time trying to correct things clients did after the fact. It would have been much easier (for all of us) if they had asked in advance.

 

[pipedream]

Again, is his agent involved in the process?

I wrote to John last night: "An agent on the forum is asking if you contacted and talked with your agent about this? Please let me know so I can respond."

I received this answer this morning: "Good morning, No, I bought this policy about 10 years ago, and really never talked to the agent again."

Now before anyone berates my brother for never talking to his agent again after purchasing the policy (remember he was healthy and did not have expenses beyond his deductible in the 10 years he has owned the policy) I have a question for you. Do agents have any responsibility to keep in touch with their long-term customers who seemingly don't have issues...who just keep paying the premiums year after year? And do you suggest he try to locate his agent now for assistance?

 

[Dave020]

Some agents are more hands-on than others, however in a situation like your brother's if he was happy with the plan and not having issues, then it is not incumbent on the agent to continually contact him.

That being said, the agent does earn continuous commission on the plan over the years and that commission is intended to provide service on the policy. The agent should be ready at any time to assist a client with claims issues if and when they arise.

Hopefully your brother's agent is still in business. Should he/she not be, it is then possible that servicing come directly from the carrier.

I believe on his premium payment statements it should list the name of his agent.

 

[pipedream]

Hopefully your brother's agent is still in business. Should he/she not be, it is then possible that servicing come directly from the carrier.

Follow-up from John as to the agent: The agent that I bought from is no longer with the agency. Another agent has apparently taken over my file. I was in the process of trying to get out of the expensive "sick" pool when I was diagnosed. I don't have any other insurance with that agent, as I was living in Anza when I first got the policy. When I told my agent that I had cancer, she said "good luck", and I haven't heard from her since..... "

 

[somarco]

I offer my clients the opportunity to opt out of a monthly newsletter. They get it automatically if they want it or not.

Almost all my business is online and over the phone. As such, I don't send out birthday cards, anniversary cards, etc. Pretty much email & phone.

I also operate on the assumption if it isn't broke, don't fix it.

If someone has an issue, they can always contact me, but I don't call my clients every month to make sure everything is all right.

 

[pipedream]

I also operate on the assumption if it isn't broke, don't fix it.

I'm sure that's how my brother operated too....unfortunately.

If someone has an issue, they can always contact me, but I don't call my clients every month to make sure everything is all right.

Every month, of course not....but I bet you would contact your clients a time or two over the course of 10 years just to see if their needs are being met. I've read quite a number of your posts here and it appears to me that you are a professional who cares about your clients, not just the $$ they bring you.