Singular Pay Loophole

[Expat]

I'm somewhat convinced that throwing daggers at the competition may not be the best way to go...but, and there's always a "but," if:

1. If a company like Golden Rule has been advised in several states that they can't issue insurance anymore because of questionable business practices, shouldn't an agent mention that? What is they get a pre-existing condition and their company leaves the state?

2. When I read a Blue Cross Policy and it says that if, during a hysterectomy surgery, they have a need to perform an appendectomy, they won't pay it (this is the example the policy uses), shouldn't you say something?

3. With Humana's plan that don't have a max out of pocket for out of network and just five years ago they canceled fifty-thousand policy holders in your state, shouldn't you say something?

Please tell me I'm wrong. Those one deductible plans, especially for a family are really expensive.

No you are not altogether wrong, what I meant by negative selling was nit picking other policies in order to make a sale. If the plan you are selling does not have enough benefits to stand on it own feet, running down the competition will only come back to bite you. It really does not matter which company or which plan you are presenting, they will all have negative points, some more than others. The bottom line is all insurance companies will maximize their profits, be it Rx caps , one incision only or limited outpatient.
Consumers will always be on the losing side, and insurance companies will get bigger and richer.........fact of life. (Albeit a sorry one)

 

[blaze1x]

No you are not altogether wrong, what I meant by negative selling was nit picking other policies in order to make a sale. If the plan you are selling does not have enough benefits to stand on it own feet, running down the competition will only come back to bite you. It really does not matter which company or which plan you are presenting, they will all have negative points, some more than others. The bottom line is all insurance companies will maximize their profits, be it Rx caps , one incision only or limited outpatient.
Consumers will always be on the losing side, and insurance companies will get bigger and richer.........fact of life. (Albeit a sorry one)

Argh! I was kinda hoping there'd be another way at looking at this whole insurance biz. I wish there was a hands down best company. Then I'd work for them.

 

[Crabcake Johnny]

There's a best health insurance company like there's a best fast food company.

 

[blaze1x]

There's a best health insurance company like there's a best fast food company.

So...what do you do, select one of the health insurance companies, do a high deductible, and supplement it with a critical illness or a hospital indemnity plan? That way you're paying a reduced fee for general medical services (annual checkups) and you're covered for the bit stuff.

 

[Crabcake Johnny]

Most of the decision of where to place a client is due to health history. If you have a lot of "clean apps" you're not doing a proper review. About 10% of what you submit will note a pre-ex condition. If it's more than 10% you and the client are playing a game of "don't ask don't tell."

Pre-ex is any time your client has sought medical attention is the past "X" months (varies by carrier.) Which means if your client has stepped into a doctor's office except for routine physicals it goes on the app.

After you dig up their true health history, that will dictate which carrier you put them with.

 

[somarco]

About 10% of what you submit will note a pre-ex condition

You must have some really healthy folks in your area. Statistically, around 80% of apps are either rated, ridered or declined. Carriers here in GA reject 40 - 50% of apps submitted.

I do a very thorough job of pre-screening & my last 2 Aetna apps have been rejected because the Rx probe does not match the app.

Since the first of the year I can recall a 24 yr old who could not qualify for coverage due to alcohol treatment, a 62 yr old martial arts competitor (non-professional) declined due to atherosclerosis and a 39 yr old female declined due to breast augmentation.

I would estimate that the majority of my clients either have riders or rate ups for some condition. I am constantly amazed when someone actually receives a preferred rate.

 

[K-Dub]

If you don't know why, you will figure it out eventually. Perhaps it will be when one of your clients wants to know why they are paying an extra $400 per month in addition to their copay for meds. By then it is too late to do anything about it.

$400 a month for most people won't send them into bankruptcy. What if my client who recently passed away had to pay 50% of her $8,000 a month cancer drug? Now that will financially devastate someone!!

I tell every client that I talk to that I will NOT show them a plan that a) I wouldn't put my own family on, b) has no name brand coverage or limits them in name brand coverage. I tell them you can probably find a plan that will be $20-50 a month less, but you won't get it or buy it from me! They never object!

BTW John, that same Aetna plan for a 45 year old family in CO is $461 a month, makes it an easy sale most of the time. Really no competition either since most agents won't sell it due to the 15% commission schedule! I thank them on a daily basis!

 

[Crabcake Johnny]

Lol - total typo on my part - as I indicated, most apps WILL have pre-ex. What I meant was 90% of the apps I submit note a pre-ex condition - only 10% are "clean."

You must have some really healthy folks in your area. Statistically, around 80% of apps are either rated, ridered or declined. Carriers here in GA reject 40 - 50% of apps submitted.

I do a very thorough job of pre-screening & my last 2 Aetna apps have been rejected because the Rx probe does not match the app.

Since the first of the year I can recall a 24 yr old who could not qualify for coverage due to alcohol treatment, a 62 yr old martial arts competitor (non-professional) declined due to atherosclerosis and a 39 yr old female declined due to breast augmentation.

I would estimate that the majority of my clients either have riders or rate ups for some condition. I am constantly amazed when someone actually receives a preferred rate.

 

[K-Dub]

I know I drive myself crazy attempting to investigate every nook and cranny - but I always place myself in the shoes of the client and don't like surprises that end up costing money. It seems that half our job is to find an insurance company to protect the client and the other half is to protect the client from the insurance company!

What I've seen a lot of agents do in the past is talk themselves right out of an application by giving too much information. I'm not saying you leave out info intentionally, but tell them what they need to know. Once you start getting into all the small caps and limitations that ALL carriers have you scare them and they show you the door!

Like I said before, I won't put you on a plan that I wouldn't put my own family on. If I know the plan is solid and it's a product that I like and believe in I will offer it and feel good about it! If the client comes back to me complaining that PT was capped at 3k a year and their bill was 4K, I'll tell them that any other carrier would treat this exactly the same. Unless you want me to quote you a group plan for $1,200 a month that would have paid the extra 1K for PT. Again, they don't object!

 

[Crabcake Johnny]

I put my clients on plans I wouldn't put my family on every day. If I limited my sales to plans I'd only buy I'd be out of business in a month.

I would never put a family member on BCBS Personal Comp. That's neither here nor there when I have a 62 year old smoker on a budget. In that case I explain all options and potential downsides to Personal Comp - then the ball's in their court. I've heard people post here before to walk way from those clients. You do that. I live my own life and sell how I want to sell.

Aetna with a $5,000 cap on drugs? Neither here nor there if GR declines and Assurant wants to rider a major on-going condition.

You're an ethical agent if you're explaining options and limitations of policies. But I'm not gonna ride that high horse and say there's only a narrow number of plans I'll sell.

Agents are whores if they sell Mega. Then you move from Mega to "good" companies but you're still a whore if you're selling Right or Saver plans. Then you're not with Mega, not selling Right or Saver plan, yet still a whore unless you're selling this insanely narrow list of plans?

Bullcrap. I sell absolutely everything and anything I long as I know in my mind that after a needs analysis I've recommend and explained the best plan they can get for their money.

If newer agents are on this board, don't be lead you to believe you shouldn't be in this biz unless you're only selling 1 or 2 plans specific plans. Screw that. Recommend some plans, explain the options and actually if you're doing high volume - not 2 apps a week - you'll have business going all over the place and a huge mixture of copay plans and HSAs.

I sell a decent amount of CoreMed. If other agents don't like it that's their burden, not mine. I'm not walking away from a GR decline due to a mental/nervous disorder, can't afford the Aetna plan with the rate-up, BCBS and Coventry won't take 'em and Max and HSA would decline or rate-up past affordability. For me every client and situation is different.