Random Thoughts, Ramblings, Ideas, Questions, Etc..

[bluediamond]

10/24/2014

Question:

From an agent's perspective, what is the difference between being contracted with a:

1. Managing General Agency (MGA)

2. General Agency (GA)

3. Field Marketing Office (FMO)

Each of these entities are discussed in various sections of the forum, but I have no idea how they relate to each other, or to agents.

For instance, if I have an issue with Blue Cross or Humana that I can't resolve myself, a support company known as Employee Benefit Risk Management (EBRM) will go to bat in assisting me. EBRM also conducts our Blue Cross field training sessions.

I asked them today if I was "under them". Here's the reply...

"We at EBRM don't sell insurance, so we don't have agents under us. We're actually the agents General Agency. This means that were the middle person between the agent and the carrier. You can think of us as your office."

OK, so they are my General Agency. But, I'm "not under them"? Whatever. I'm glad to have them available for assistance and training.
ac

Well Allen let me give this an attempt: Have you signed anything with EBRM?

FMO are field marketing organizations and usually represent several insurance company's and one step down in the commission structure from corporate. Usually an MGA is representing one company a step down from a company or even a FMO. MGA's appoint GA's, another step down, then the agent or producer. Everyone get's a piece of the pie until it gets to you. It is possible an agent can also be a GA, and if you are then the line stops with you, unless you hire agents under you. No wonder you're confused, I am just typing this and may have left something out.

Oh if EBRM is your GA then they are keeping some commission or getting paid elsewhere, they are not helping you for free.

 

[HoosierLife]

Well Allen let me give this an attempt: Have you signed anything with EBRM? FMO are field marketing organizations and usually represent several insurance company's and one step down in the commission structure from corporate. Usually an MGA is representing one company a step down from a company or even a FMO. MGA's appoint GA's, another step down, then the agent or producer. Everyone get's a piece of the pie until it gets to you. It is possible an agent can also be a GA, and if you are then the line stops with you, unless you hire agents under you. No wonder you're confused, I am just typing this and may have left something out. Oh if EBRM is your GA then they are keeping some commission or getting paid elsewhere, they are not helping you for free.

That's the way I understand it. I know, for some carriers, I have GA contracts and others are MGA levels. But that's just what a piece of paper says. I might still be at sub-GA levels and not know it.

 

[AllenChicago]

Well Allen let me give this an attempt: Have you signed anything with EBRM?

FMO are field marketing organizations and usually represent several insurance company's and one step down in the commission structure from corporate. Usually an MGA is representing one company a step down from a company or even a FMO. MGA's appoint GA's, another step down, then the agent or producer. Everyone get's a piece of the pie until it gets to you. It is possible an agent can also be a GA, and if you are then the line stops with you, unless you hire agents under you. No wonder you're confused, I am just typing this and may have left something out.

Oh if EBRM is your GA then they are keeping some commission or getting paid elsewhere, they are not helping you for free.

I did sign something back in 2004, but don't recall what it was now. Since every commission schedule I see from BCBS-IL HQ matches what I'm paid per sale, there must be something extra paid to EBRM directly from BCBSIL.

Thanks BlueDiamond for chiming in with your thoughts on what the general role of the MGA/GA/FMO in relation to brokers. Blue Cross is the only company where there is an intermediary (EBRM) between myself and the insurer. The BLUES are different in a lot of ways it seems.
ac

 

[AllenChicago]

October 28, 2014

Back before ObamaCare fully kicked in, several health insurers offered plans that paid "reasonable and customary" medical bills. They did not have any Provider Network affiliation. These plans also cost (costed?) significantly more than their PPO counterparts.

Did ObamaCare outlaw these plans, or did companies simply choose to stop selling them? A METAL policy which pays reasonable and customary would alleviate the anxiety over narrow, or no networks, in some parts of the country, wouldn't it?
ac

 

[Ann H]

Those plans mostly went away pre-Obamacare, but now post-Obamacare the new game is "networks on a diet". Last year was bad with anorexic networks. This year there are more network games being played. So, the carrier that offers a "no network" reasonable & customary reimbursement plan is the bullseye target for adverse selection.

 

[AllenChicago]

Those plans mostly went away pre-Obamacare, but now post-Obamacare the new game is "networks on a diet". Last year was bad with anorexic networks. This year there are more network games being played. So, the carrier that offers a "no network" reasonable & customary reimbursement plan is the bullseye target for adverse selection.

Why would the sickest Americans flock to this carrier Ann? They would be the group least likely to subject themselves to tons of "balance billing" charges, one would think.

 

[Ann H]

You are balance billed either way. On the R&C plan you may be balance billed, yet have 80% co-insurance because there is no difference between in-net and out-of-net. With a PPO, you are still balance billed for out-of-net providers, but with a separate deductible, separate out-of-pocket, and a lower co-insurance (like 50% for instance). That makes the R&C plan more attractive to high utilizers who intend to use places like Mayo Clinic that rarely participate in Networks.

 

[Yagents]

I love the spin..........

https://screen.yahoo.com/hhs-obamacare-cancellations-aren-t-133117471.html

According to a top Health and Human Services official, the millions of health insurance cancellations caused by Obamacare don't mean people are "losing insurance — they just mean people are being invited to join an Obamacare exchange. HHS regional director Joanne Grossie spoke to the Virginia legislature about widespread cancellations. At least 250,000 Virginians will be losing their health insurance Jan. 1 because they don't meet Obamacare regulations. Republican state Sen. Jeff McWaters asked Grossie whether HHS knows how many people are going to lose coverage, but Grossie took issue with the idea that customers are even losing insurance.

 

[AllenChicago]

You are balance billed either way. On the R&C plan you may be balance billed, yet have 80% co-insurance because there is no difference between in-net and out-of-net. With a PPO, you are still balance billed for out-of-net providers, but with a separate deductible, separate out-of-pocket, and a lower co-insurance (like 50% for instance). That makes the R&C plan more attractive to high utilizers who intend to use places like Mayo Clinic that rarely participate in Networks.

Got it. Thanks for explaining this in your usual, thorough manner Ann!
allen

 

[somarco]

Was she given a drug test after the meeting? She had to be stoned to deliver that line with a straight face.