HMO Vs PPO

[ABC]

I am selling Advantage. They really just became competitive in the last year. Prior to that I was an HMO called M-plan which was owned by the Clarian. Which was a great sale due to their network.

Advantage is owned by St. Vincents.

So the big problem is Advantage does not have Clarian or University Hospital. This is a big problem because Clarian has the best Hospital in the city.

It comes down to how bad do people want to save money.
If you have a controller or owner making the decision and their Doc. is not in network its a very tough sale.

I will sell any group no matter what the age is. I don't understand why I would only sell young groups?

 

[patch36]

Sorry, I mistook Advantage for Medicare Advantage. Nevermind

 

[keepfocussecurity]

Please what means HMO vs PPO ????

 

[SBSpartan]

There are benefits to both plans. I don't think its wise to shut down an option at any point because you personally don't like it. You always have to do what is best for your client.

 

[stuy119]

You're also fighting perception. Sicko and all of the cases of denied claims were on HMO plans, not PPO (a lie of omission).

HDHPs are the way to go, with a small employer contribution to start the HSA (so they don't feel they are losing all first-dollar benefits). I've actually seen a 5% average DECREASE in rates on my HDHP clients vs. a 10% average increase on PPO/POS clients.

 

[ABC]

You're also fighting perception. Sicko and all of the cases of denied claims were on HMO plans, not PPO (a lie of omission).

HDHPs are the way to go, with a small employer contribution to start the HSA (so they don't feel they are losing all first-dollar benefits). I've actually seen a 5% average DECREASE in rates on my HDHP clients vs. a 10% average increase on PPO/POS clients.

Your 100% right about perception and that why I started this thread. The HMO's of today are hell of a lot different than those of the 80's. I am also selling a POS option with the HMO so if someone want to go out of network they can.

When you talke about reducing rates with an HSA the majority of my block is HSA business. The HMO I am selling/trying has an HSA option that is a serious reduction in price.

There are some huge benefits with diagnostic services with an HMO.

 

[speckled horn]

When I did some business out in California a year or so ago, Kaiser had an unbelievable. HMO that was "qualified". The premium was HALF of a rich PPO plan. The ER could pay 100% of EE and Dependent and in most situations had enough savings to fully fund the $1500 deductible for the EE. Left a ton of money for the ER to contribute to dependent deductible or put in his pocket. CRAZY!!! $0 out of pocket for health care as an employee...now that's a rich benefit!

Utilization is another issue.

My resident state is TX and HMO's here are almost double the premium as a PPO. You guys that have HMO's priced well are lucky.

We mainly sell embeded HDHP's here and pair with HRA or HSA's.

Good luck to all.

 

[ABC]

Well, it looks like I am picking one new client on the HMO.

The savings was almost 45% pre underwriting. So I am hoping there are no health conditions on the apps. The group is 7 females and 1 guy all under the age of 45. Knock on wood for clean apps.

 

[Guest]

abc

Don't get me wrong I am not trying to tell you how to sell but it sounds like you've given 3 different objections your prospects have.

1. Past problems with the industry.
2. Past problems with a specific hmo no longer around.
3. Your hmo's hospital has a lower value in the p's mind than clarion.

These are really common business objections. It doesn't sound like you isolated all objections initially and didn't get a committment that if you could address all of the prospect's concerns to his/her satisfaction that he/she would be willing to move ahead on this.

If you don't isolate all of the objections you haven't asnwered all of your prospect's questions in his/her mind as to why I should change.

If you can't get a committment from him/her to move ahead if you have addressed those ?'s then you're wasting your time and should find another prospect to talk to because they don;t have enough pain yet to do something about it.

Just put them in your tickle file and move on.

Just my 2 cents.

 

[ABC]

abc

Don't get me wrong I am not trying to tell you how to sell but it sounds like you've given 3 different objections your prospects have.

1. Past problems with the industry.
2. Past problems with a specific hmo no longer around.
3. Your hmo's hospital has a lower value in the p's mind than clarion.

These are really common business objections. It doesn't sound like you isolated all objections initially and didn't get a committment that if you could address all of the prospect's concerns to his/her satisfaction that he/she would be willing to move ahead on this.

If you don't isolate all of the objections you haven't asnwered all of your prospect's questions in his/her mind as to why I should change.

If you can't get a committment from him/her to move ahead if you have addressed those ?'s then you're wasting your time and should find another prospect to talk to because they don;t have enough pain yet to do something about it.

Just put them in your tickle file and move on.

Just my 2 cents.

Thank you for the response

The 45% savings is what is releiving both the company's and empolyee's portion of the premium.

All of the employees doc.'s are in network. That is the key to the HMO sale. Because the plan design is actually better than PPO plan because there are richer benefits.