NOT a political post but a legit question

[sshafran]

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.

I would agree with you there - that if an agent fails to disclose something, there is an issue.

I self-enrolled and didn't talk to an agent. In my opinion, the website was pretty clear.

My point above was to illustrate that even if you tell a person month by month what their copays will be, that often they don't listen and claim that the agent mis-led.

In other words, how many more times do they need to blast on their website "this is not insurance?"

 

[scagnt83]

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.

You completely missed the point. This guy was not complaining.

Any agent who's done this for more than a month knows that consumers forget what is said all the time.

For you to imply that is always the problem (I gave 1 of many examples) is the equivalent of hiding your head in the sand. I have encountered many people in groups who opted out because they had Sharing Plans... when I ask them about the exclusions, they always mention abortion and drugs and unmarried moms... they never mention the 20 other things... and only a couple knew that any claim at all can be denied at any time for any reason...

 

[LostDollar]

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.

I can't remember somarco's exact words and can't turn the post up easily, but what you described sounds exactly like Medigap consumer behavior somarco recently said agents could expect.

 

[scagnt83]

I self-enrolled and didn't talk to an agent. In my opinion, the website was pretty clear.

You are an agent, big difference between you and the average consumer.

 

[somarco]

Scott, what do you use to record the calls? I have looked at these in the past but never pulled the trigger. Probably should look again. Might be something easier than having my parrot listening in.

While I don't record calls, I do take notes, and send a follow up email summarizing our conversation.

Because PDP's are insanely complicated, I send the Medicare comparison report showing 2 or sometimes 3 plans side by side. Also send the monthly expanded cost report with the estimated copay's for their preferred pharmacy. To close out the trifecta, I send the drug list report used to generate the reports.

And I track the emails so I know if they are opened and clicked or not.

All this comes in handy because the consumer, and sometimes the agent, forgets what is said. This is particularly helpful for the SEVERAL calls I get during the year about how their drug plan works.

Got a call yesterday from a client that said his drug plan is not the same one we discussed. He wanted to know why I enrolled him in Express Scripts and not the plan we discussed. I pulled up all emails and reports and Express Scripts was not showing up anywhere.

Digging further I found out his employer had SEAMLESSLY ENROLLED him in a Medicare Advantage and drug plan of their choice. This is a very large employer. I don't have the details on their MA plan but it does not include Rx.

This man's wife has a LOT of health issues. He had investigated and decided against an MA plan before he called me a couple of months ago. She would hit the plan OOP every year so he wanted Medigap for both.

She also has several med's, some are quite expensive.

One of her med's is not on the Express Scripts formulary and her med copay's are double the Symphonix plan I suggested.

So . . .

Armed with this information I told him to call HR and disenroll from the MA and Rx plans. Fortunately it was not too late to unwind what his employer had done.

In this case he remembered our discussions and knew something wasn't right, he just didn't know what his former employer had done.

 

[sshafran]

Scott, what do you use to record the calls? I have looked at these in the past but never pulled the trigger. Probably should look again. Might be something easier than having my parrot listening in.

I use Zoho CRM and my phone is integrated with it (via Twilio). When "John Smith" is calling my CRM allows me to answer and immediately pull up his file with all info and it automatically records the call and attaches the recording to his file... time stamped and everything.

On my cell I use ACR. I rarely have clients call the cell, but it happens on rare occasions.

Your e-mail method is excellent. Often I'll do the same or similar but didn't in this particular scenario. I did, however, have the .pdf of that PDP illustration attached to her file in my records and was able to send it.

 

[sshafran]

I use Zoho CRM and my phone is integrated with it (via Twilio). When "John Smith" is calling my CRM allows me to answer and immediately pull up his file with all info and it automatically records the call and attaches the recording to his file... time stamped and everything.

On my cell I use ACR. I rarely have clients call the cell, but it happens on rare occasions.

Your e-mail method is excellent. Often I'll do the same or similar but didn't in this particular scenario. I did, however, have the .pdf of that PDP illustration attached to her file in my records and was able to send it.

Outbound works the same way. Click "call" in John's file and it all stays there.

 

[springbokhouston]

I joined Liberty Healthshare this year after the only "Bronze" option in my area got up to almost $1500/month. My deductible per person was "only" $6500 with a family MOOP of around $15,000. I've been paying through the nose year after year with no relief. I've got a little more time to go before I hit Medicare, but the U65 market is an absolute mess and I'm willing to take my chances.

 

[junkman]

I joined Liberty Healthshare this year after the only "Bronze" option in my area got up to almost $1500/month. My deductible per person was "only" $6500 with a family MOOP of around $15,000. I've been paying through the nose year after year with no relief. I've got a little more time to go before I hit Medicare, but the U65 market is an absolute mess and I'm willing to take my chances.

This is why I bailed from ACA this year. Family is on Farm Bureau administered by UHC. ACA premiums were so high that penalty was non-existent. I couldn't pass underwriting and hope I don't get sick and that claims are paid if I do but I'll have most of my OOP in premium savings.

We have a cluster ... headache for a healthcare system or something like that.

 

[LostDollar]

This is why I bailed from ACA this year. Family is on Farm Bureau administered by UHC. ACA premiums were so high that penalty was non-existent. I couldn't pass underwriting and hope I don't get sick and that claims are paid if I do but I'll have most of my OOP in premium savings.

We have a cluster ... headache for a healthcare system or something like that.

Looks like Kansas is going to have a non-ACA-compliant Farm Bureau option for 2020.