NOT a political post but a legit question

[somarco]

He ASSUMED that "since it is like insurance, they are legally obligated to pay valid claims". He also was never told about most of the exclusions. He actually thought he could sue if they denied payment!

THIS ^^^^^

Not regulated by the DOI. Recourse is civil action with a private attorney, possible criminal action involving the local DA or possible state AG.

Some of the sharing plans and other bogus arrangements have been pursued by the AG and shut down.

In spite of that, claims went unpaid and the folks at the top are presumably still in a warm climate sipping drinks with little umbrellas.

 

[scagnt83]

Some of the sharing plans and other bogus arrangements have been pursued by the AG and shut down.

In spite of that, claims went unpaid and the folks at the top are presumably still in a warm climate sipping drinks with little umbrellas.

Exactly.

Bernie Madoff processed withdrawal requests for decades... until one day he didnt anymore...

These Plans have zero legal obligation to publish financial info. The little bits of info they do disclose, are nothing like what an insurer has to publicly disclose.

There is zero way of knowing if any (or all) of them are a ponzi scheme or not. And since they have zero legal obligation to pay claims... what can the "members" do about it if they do stop paying claims? It is perfectly legal for them to not pay claims... unless they violate some type of consumer protection law.

 

[somarco]

These Plans have zero legal obligation to publish financial info. The little bits of info they do disclose, are nothing like what an insurer has to publicly disclose.

I knew we would once again find common ground.

 

[sshafran]

But myself, and many other agents on here, certainly do have experience with consumers understanding of these products.

Example: Accomplished CPA with a very small firm. Very smart, very successful, very religious.

He had no clue (Why? Did they hide it from him or did he just forget to read?) about any of it. He ASSUMED that "since it is like insurance, they are legally obligated to pay valid claims". He also was never told about most of the exclusions. He actually thought he could sue if they denied payment!

Forgive me for seriously failing an empathy test, but I'm not getting overly emotional about this man being "swindled." Nor would I ever want him near my taxes.

I read over my "exclusion" list about 3 times before signing up. Loved the fact that my cash wasn't going to pay for others to kill babies for profit and convenience (or the sanitized word that people like to use: abortion).

These companies have no obligation to point out every single way that they are different from insurance.

Really. They don't.

Should they be more clear? Maybe, but that's debatable. But when I bought medi-share I knew exactly what I bought into.

A group of like-minded people agreeing to share bills of others in the group, using a network of providers. We also agree, as a group, that some things will be excluded. It's not that difficult.

 

[sshafran]

To be clear - I don't sell it. I've never even looked into selling it.

 

[LostDollar]

Also, you do not know whether they understand it or not.

I believe scagent made a post that addresses that issue from a viewpoint of an insurance agent with experience.

 

[LostDollar]

Forgive me for seriously failing an empathy test, but I'm not getting overly emotional about this man being "swindled." Nor would I ever want him near my taxes.

I read over my "exclusion" list about 3 times before signing up. Loved the fact that my cash wasn't going to pay for others to kill babies for profit and convenience (or the sanitized word that people like to use: abortion).

These companies have no obligation to point out every single way that they are different from insurance.

Really. They don't.

Should they be more clear? Maybe, but that's debatable. But when I bought medi-share I knew exactly what I bought into.

A group of like-minded people agreeing to share bills of others in the group, using a network of providers. We also agree, as a group, that some things will be excluded. It's not that difficult.

So, one of the common points of view expressed to new agents on the forum is that they should work to develop relationships of trust with their clients.

Now we are dinging insurance consumers for trusting their agents?

 

[sshafran]

So, one of the common points of view expressed to new agents on the forum is that they should work to develop relationships of trust with their clients.

Now we are dinging insurance consumers for trusting their agents?

Consumers have a responsibility to listen.

Let me give you an example. An accomplished realtor bought a PDP from me. Her meds were incredibly expensive.

I asked her for her med list, which she e-mailed me. I ran her report, then called her (3/9) and said, and I quote myself, "Your first month is estimated to cost you $3,000 in copays. After that, it'll go down to $950 monthly for the rest of the year" I then went into some details. She said "OK" to everything and we enrolled.

5/2 she e-mailed me, "Scott, this plan is horrible and is not the story you sold me. They won't even cover "x" medication, and my copays are $1,500. You told me maybe $500 monthly. What can you do to fix this?"

A few things:

The one med that wasn't covered was not on the list that she e-mailed me. How could I verify coverage for something that she didn't send me? Secondly, I told her $3,000 first month then she'll hit catastrophic phase and it'll go down to $950.

My recorded call verified that I told her exactly what I should have. Her e-mail to me verified that she heard exactly what she wanted to hear. The details were too boring for her to pay attention to, apparently.

My gut feeling is that the CPA did a horrible job listening and didn't bother to read the exclusions. Again, I wouldn't want him to do my taxes - just like I wouldn't want my PDP client to sell my house.

The customer is not always right.

 

[scagnt83]

Forgive me for seriously failing an empathy test, but I'm not getting overly emotional about this man being "swindled." Nor would I ever want him near my taxes.

I read over my "exclusion" list about 3 times before signing up. Loved the fact that my cash wasn't going to pay for others to kill babies for profit and convenience (or the sanitized word that people like to use: abortion).

These companies have no obligation to point out every single way that they are different from insurance.

Really. They don't.

Should they be more clear? Maybe, but that's debatable. But when I bought medi-share I knew exactly what I bought into.

A group of like-minded people agreeing to share bills of others in the group, using a network of providers. We also agree, as a group, that some things will be excluded. It's not that difficult.

Wow. Talk about taking offense. I see this is a sore spot for you.

If you think most consumers read insurance contracts, then you are a fool.

And I never said anyone should feel bad for him. Like you, he had religious reasons for wanting to stay in the plan in addition to financial reasons. But he also has a safety net... he can start a group plan with GI at anytime. And in his words "the premiums are so low, it wont be a major lose if they go belly up... and then I will just start a group plan".

I used him as an example because he is more financial and business sophisticated than most... and he still wasnt fully informed. Why? Because he trusted that an insurance agent would fully disclose everything about the policy they are selling. He was aware of the 4 or 5 "main exclusions" but not the 15 or 20 others.

 

[scagnt83]

These companies have no obligation to point out every single way that they are different from insurance.

Really. They don't.

Should they be more clear? Maybe, but that's debatable. But when I bought medi-share I knew exactly what I bought into.

They have no legal obligation... because they are unregulated!

Morally, well, they are recruiting insurance agents to sell it. They use insurance lingo and terms within the advertising and contract. They market it as doing the same thing as insurance.

They do everything they can to make themselves seem like real insurance... yet as "Christians", they feel no moral obligation to fully differentiate their product from real insurance? That sounds like the exact opposite of what Christian morals exemplify.

---

But I blame the agents selling it more than the companies. Agents are selling it under the same "hat" as selling insurance. They often pitch it to people that they initially prospected for real insurance.

It is the agents who need to offer greater transparency and disclosure. They are the ones with the most at risk. And they have just as much "moral peril" as the company does.