Should I sell for UnitedAmerican or Assurant

[STIBROKER]

You need Assurant and UA ...

really.......here is what I am dealing with right now.....

plus.....

ambulance..$651.12(being counted out of network.....had my client call the insurance company and ask what ambulance service is in network ...answer none....we are appealing this one on life and death emerg. and no reasonable provider in network)

emerg room $1383

then a bunch of $200 here's and $20.00 here.....



total to date.....$88,342.47....and new bills coming in each day.....now what plan would you like to have,............




and btw john....If they would have been on a family hsa for $10,000 his stop loss on his plan is $5,000 and it happened in march......the hsa...he would have to pay an add $5,000.....

 

[BKrocko]

Interesting.........I was speaking with a couple of other forum members the other day about how ambulance charges were billed. We knew that they were all "out of network" but did not really know how it was billed. Does it count toward a separate "out of network" deductible? The bottom line is that the client will usually pay for the entire ambulance ride/service but will it all count toward deductible? It is not even clear when we read a copy of the policy. Lord help anyone who needs to be air lifted - billed round trip, avg. about 15K - 20K. Most policies limit it to 5K applicable toward deductible. Assurant does have one of the only provisions that will cover it - maybe that's why they are pricing themselves out of so many markets!

 

[J.R.]

Interesting.........I was speaking with a couple of other forum members the other day about how ambulance charges were billed. We knew that they were all "out of network" but did not really know how it was billed. Does it count toward a separate "out of network" deductible? The bottom line is that the client will usually pay for the entire ambulance ride/service but will it all count toward deductible? It is not even clear when we read a copy of the policy. Lord help anyone who needs to be air lifted - billed round trip, avg. about 15K - 20K. Most policies limit it to 5K applicable toward deductible. Assurant does have one of the only provisions that will cover it - maybe that's why they are pricing themselves out of so many markets!

I take it you are talking about Colorado plans or do you sell in other states? Air lifting is VERY expensive. I had a close friend who had to be flown from MD to PA last year.

The only plans I know of the the mid-atlantic area that clearly state what they cover or do not cover for Ambulance are Assurant and Anthem-BCBS and if I recall correctly, there is some information on GR's website. Havent' checked with Conventry yet, but John P. might know.

 

[Frank Stastny]

I am a new agent and have an offer from 2 agencies..oneagency to sell United American...the other agencyis selling Assurant

I am a new agent, with very little experience...any help appreciated

They are totally different types of insurance. Both have their place.

It is like asking if you should sell apples or oranges. Some people will want oranges, if a prospect can't afford the oranges and is hungry they may purchase the apples from you.

I would suggest that you get detailed information on both and study it. Each is going to have advantages and disadvantages. Then take a close look at the people you want to market to.

It is really only a decision you can make after doing the research.

 

[Crabcake Johnny]

Yes, I've had an interesting conversation with a few people regarding how ambulance is covered. Obviously all ambulance is out of network since most are privately owned companies. I've looked at a few policies and none have any specific language - just that ambulance is covered. Since there's no network contracts do insurance companies simply pay the bill whatever the bill might be? Will Assurant, GR, Blue Cross pay a $15,000 air ambulance bill?

 

[Crabcake Johnny]

really.......here is what I am dealing with right now.....

plus.....

ambulance..$651.12(being counted out of network.....had my client call the insurance company and ask what ambulance service is in network ...answer none....we are appealing this one on life and death emerg. and no reasonable provider in network)

emerg room $1383

then a bunch of $200 here's and $20.00 here.....



total to date.....$88,342.47....and new bills coming in each day.....now what plan would you like to have,............




and btw john....If they would have been on a family hsa for $10,000 his stop loss on his plan is $5,000 and it happened in march......the hsa...he would have to pay an add $5,000.....

Trust me Scott, I'm becoming less pleased with HSAs as I call my clients back for renewals. Most of them are complaining - not seeing any benefit. What I hear most often is:

"I have to pay my premiums AND all these other bills."

It's not about what you're saving people. It's about what fits in their budget and their perception of getting value. So if a $360 copay plan fits comfortable in their budget I no longer bring up a HSA for $310.

 

[STIBROKER]

Obviously all ambulance is out of network since most are privately owned companies.

not necessarily.....the provider I am dealing with on this is the city of austin.....which has already stated they are in no ones network and when you dail 911 guess who you get....

It's not about what you're saving people. It's about what fits in their budget and their perception of getting value.

that is why you have to feel your clients out hard....some will get it....most will not.....now I have moved people that have bitched about the rate increase on their copay plan and moved them to HSA'S.....then they get it....

 

[SME]

The following is just my understanding and knowledge of the ambulance fees.
No ambulance providers are contracted, they don't have to be. Just as many ER docs are not contracted. This is usually handled 2 different ways.
1. It is a true emergency outside of a medical facility: In this case the fees should be applied to in-network benefits if the member has one of 3 clauses in thier contract.
First is the single provider clause- which means that if no in-network provider is available charges are paid as in-network. You usually have to appeal this claim to get it paid.
Second is the true emergency clause where emergencies are paid as in-network when outside of a servicable area. The hard part here is meeting the criteria for the true emergency clause to justify the ambulance ride.
Third is the No Say No Pay clause- (not available under UHC or Golden Rule) This clause states that if the member is unable to verify if the provider is in or out of network due to a medical condition or if the member had no say in which ambulance was called it is paid as in-network.

2. Medical Transportation between medical facilities. In this case ambulance charges are paid as in-network if the client has one of the following clauses in thier contract:
1. Ancillary Charge Clause: This clause states that any approved treatment recieved inside an in-network facility will be paid as in-network even if the provider is not contracted. For ambulance transfer from a non contracted facility to a contracted facility the request for transport must be made by the in-network facility in order to apply. If the out of network facility requests transport from an out of network ambulance the clause does not apply.
Or the Single Provider Clause.

Because the providers are not contracted if they are paid as in-network the carrier accepts 100% of billed charges with no discounts. If they are paid as out of network then only the usual and customary charges are accepted. The client is responsible for the additional cost.

Hope that helps.

 

[trvlnut]

Good stuff Steph

 

[J.R.]

The following is just my understanding and knowledge of the ambulance fees.
No ambulance providers are contracted, they don't have to be. Just as many ER docs are not contracted. This is usually handled 2 different ways.
1. It is a true emergency outside of a medical facility: In this case the fees should be applied to in-network benefits if the member has one of 3 clauses in thier contract.
First is the single provider clause- which means that if no in-network provider is available charges are paid as in-network. You usually have to appeal this claim to get it paid.
Second is the true emergency clause where emergencies are paid as in-network when outside of a servicable area. The hard part here is meeting the criteria for the true emergency clause to justify the ambulance ride.
Third is the No Say No Pay clause- (not available under UHC or Golden Rule) This clause states that if the member is unable to verify if the provider is in or out of network due to a medical condition or if the member had no say in which ambulance was called it is paid as in-network.

2. Medical Transportation between medical facilities. In this case ambulance charges are paid as in-network if the client has one of the following clauses in thier contract:
1. Ancillary Charge Clause: This clause states that any approved treatment recieved inside an in-network facility will be paid as in-network even if the provider is not contracted. For ambulance transfer from a non contracted facility to a contracted facility the request for transport must be made by the in-network facility in order to apply. If the out of network facility requests transport from an out of network ambulance the clause does not apply.
Or the Single Provider Clause.

Because the providers are not contracted if they are paid as in-network the carrier accepts 100% of billed charges with no discounts. If they are paid as out of network then only the usual and customary charges are accepted. The client is responsible for the additional cost.

Hope that helps.

Anyway you can translate that so 99% of the people who buy insurance can understand the clauses