HMO Vs PPO

[ABC]

I have started pitching a local HMO as a cost effective approach to group health. I have sold them in the past.

When I pitch them now I am trying to stay a way from terms like managed care, restrictive, and other terms that do not sound health care friendly.

The bottom line is if the owners Doctors are not in network its a no go.

Any of you brokers selling HMO's?

If so are you having any success and how are you pitching it?

 

[ABC]

I have an HMO I have pitched about 10 times since I first posted this.
So far not getting much positive feedback. I explain that the HMO's of today are nothing like that of the 80's. I am even selling it with a POS if they want to go out of network.

I have one taker but I don't think I am going to get the group through underwriting. There is another potential but that its.

The rates are about 25% under market of the most competitive PPO plan. You would think in the economy people would be like OK.


Am I the only one on here selling HMO's?

 

[patch36]

I have them but never sell them. My PPO's are the same price with a little higher co-pays, which sounds like a luxury you do not have. Potential clients for the most part do not like the concept of the HMO. Many have had bad experiences or have heard of others with bad experiences. They think they do not want to be told by a gate keeper physician when they can go to Specialists, etc, but most of them do that very thing when dealing with their PPO Drs. But, with the PPO they have the choice, something they place a high value on.

 

[ABC]

I have them but never sell them. My PPO's are the same price with a little higher co-pays, which sounds like a luxury you do not have. Potential clients for the most part do not like the concept of the HMO. Many have had bad experiences or have heard of others with bad experiences. They think they do not want to be told by a gate keeper physician when they can go to Specialists, etc, but most of them do that very thing when dealing with their PPO Drs. But, with the PPO they have the choice, something they place a high value on.

Yep I am dealing with people not wanting to except the restrictions of an HMO. My rebuttal to them on this is the POS addition to the plan. So if someone wants to go out of network for a surgery they can. My big obstacle is the HMO does not have one of the major hospitals in my city. The reason is because the HMO is owned by the other major hospital.

I pitched last week to a group and might be able to bring 30% savings on a 7 life group. 30% is a huge savings for any group but the owner threw out I don't want to be told where to go for treatment. I explained that in todays market most specialists will not see you with out some type of referral.

The other obstacle I have in here in Indianapolis was the other local HMO in town folded about 2 years ago and everyone remembers.

It just surprises me in this market people still are hesitant about HMO with the kind of savings they bring.

 

[patch36]

Would you buy an HMO after what you just told us? No hospital and the only other one in town folded ?

 

[ABC]

Would you buy an HMO after what you just told us? No hospital and the only other one in town folded ?

Actually its just one of the hospitals chains out of 4 in town but its the major hospital on the north side and guess where most of the business owners live....yep the North Side.

The other HMO folded not because they were not profitable but the hospital that owned them did not want to invest the money into technology. I cant blame them. I sold many groups on the plan and had to scramble to get them switched.

For 30% saving for the basically the same benefit, yes I would buy it. Where I am really pressing the sale is where the employees are paying 50% of the employee cost. Take a family and the employee is paying $200 a week but now we can cut that down to $140 that is a big savings.

I really think once people get into the HMO system they have no problems with it. The HMO of today is a PPO look a like.

 

[patch36]

I misunderstood. I thought you meant it did not have any of the hospitals in town. It has all but one. duh on my part.

 

[IAC.Ryan]

I have an HMO I have pitched about 10 times since I first posted this.
So far not getting much positive feedback. I explain that the HMO's of today are nothing like that of the 80's. I am even selling it with a POS if they want to go out of network.

I have one taker but I don't think I am going to get the group through underwriting. There is another potential but that its.

The rates are about 25% under market of the most competitive PPO plan. You would think in the economy people would be like OK.


Am I the only one on here selling HMO's?

Are you selling Advantage? I have a guy in Fishers / Carmel that seems to be doing well with it. (Much to my dismay) I can check with him to see if he'd mind me giving you his info if you'd like.

 

[patch36]

I have a friend in Carmel selling Advantage doing very well. I assume ABC is talking younger clients though.

 

[IAC.Ryan]

I have a friend in Carmel selling Advantage doing very well. I assume ABC is talking younger clients though.

I'm not sure that age should come into it too much? Actually, I'd think younger clients would be more likely to jump based on price as they might be too young to have experienced / Remember HMO issues in the past.

(And depending on the size and makeup of the group, Composite Rating on the PPO Plan can really skew the numbers for the younger employees making an HMO even more attractive)
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I have a friend in Carmel selling Advantage doing very well. I assume ABC is talking younger clients though.

Just to clarify, I'm referring to Advantage Health Solutions