Discussion in 'Health Insurance and Ancillary Benefits' started by Bob Johnson, Oct 19, 2016.
47 yr old male = $86/mo for $2500 deductible, $125 with $0 ded
57 yr old is almost double
46 old female
Molina $6650 Deduct: $279
BCBS $6850 Deduct: $413
Might as well buy BCBS
Reviving this thread...
Has anyone had any experience with the Philadelphia American Indemnity plan?
Good, bad or ugly?
Glad I found this thread. I was offered a deal selling Philadelphia American Health plans with leads free. Upon further research it looks like the have dropped a lot of their customers in the grease by not paying claims and are in lawsuits with a lot of them, they even have a Mediation Clause in their policies so they don't have to have expensive trials. Some people were stuck with huge hospital bills of $20K or more when these clients thought they had health insurance.
These kind of plans may not get someone admitted to a major hospital for a big operation .I know people are making money selling this with the critical illness and accident attached because the price is way less then the Marketplace plans, but I am thinking I might get sued ! Does anyone else sell these types of plans as Obamacare alternatives ?
Were are an FMO with Philadelphia American so I know first hand about the inner workings of the company. I am also somewhat biased because I know they have the best products in the Defined Benefit / Indemnity space. I have done a comparative analysis of other indemnity plans in the marketplace for both benefits and rates and with their new "hybrid" plan and value added benefits, PALIC is the most benefit rich plan in that vertical.
As far as claims payment goes, I don't deal with hearsay, I deal with facts. To say Philadelphia American leaves their "clients in the grease" coming from someone who has 2 posts on this forum I have to question. All our clients claims have always been paid promptly and we have never had a problem with PALIC leaving our clients "in the grease" as was put in a previous post.
However, with that being said, from my 34 years in the health industry, let me educate the unknowing how claims are paid on Defined Benefit, Fixed Benefit or Indemnity plans. They pay a fixed benefit amount per the policy, and not a percentage of the claim. The main reason any insurance company that sells indemnity products has issues with claims is because the agent did not represent (or mis-represented) exactly how the product worked to the prospective client. They did not take the time to educate the prospect on how the plan works and pays. Imagine that an agent putting his/her commission ahead of taking care of a client. Or maybe the agent just did not know any better because they were not trained properly from there manager or FMO.
Thru our extensive training programs, we make sure all our managers and their agents, first understand how any product we represent works and second, are able to explain how the plan works to the prospective client. Once the prospect understands how the plan works, they can then make an educated decision what plan will best fit their needs.
I've sold a lot of Philadelphia American and it's a good plan but that being said there are some big holes. For example had a hysterectomy the operating room charge was about 27K total bill was about 45K client was out of pocket about 18K. The plan pays a fixed amount. On the flip side, I've had a client profit off of an injury about $1900 again the plan pays a fixed amount. Both of those cases are my worst and best cases I've dealt with.
You should always offer the ACA plans first but some clients just don't have the money. Keep in mind not all clients are suited for that product.
When it's all said and done my experience has been pretty good.
Assuming the policy owner can read, they bear some responsibility if that happens. If they would take time to read their policy and outline of coverage, they would know what the will and will not pay.
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