client's minds

[BKrocko]

I received the following email from an existing client. They have had the policy for about a year now. The policy is a World 5K/100% & also have a 5K accident policy. Premium is $195/mth plus $25.95 accident. Family of 4 = 2 adults (33/34) & 2 kids (1/6). Good income for family. I know that a large part of our responsibility is to educate the customer and I have done that. He understands the concept but wife does not want to accept reality.

email:
Hey we have a question about the accident insurance. Is this coverage available without health insurance? We’re looking at the premiums and the amount we still end up paying and it seems like we might be better off without any insurance just paying for our bills as they come. The accident policy is interesting though but just not sure if we can do that without a regular health coverage plan in place. I know this is a bit out there but let me know your thoughts and we can chat more soon. Have a great night!

They did have a bad health year - 1 yr old had ear infections and held her breath once (don't know the tech term). Their doc recommended that she see a cardiologist and have some tests run. They had the test run and everything came out negative (good news). Bill came out to be $2100 after PPO discount applied toward deductible. Total for 1 yr old this year is about $2500.

Wife went and had a total physical (prior to 13th month on policy) because she was feeling tired (results were fine). Total billed was $182 - not covered due to preventative - had she waited till the 13th mth, she would have received $200 wellness benefit (they knew about this).

I know that I will easily save this account after talking some sense to them and showing them some actual bills of what can happen. She used to have a large group policy (years ago) and wants that type of coverage but almost fainted when I showed them the true cost.

I am working with them on new quotes - lower deductible, 80/20 plans, HSA etc.

Point is - people are spoiled by group plans and want everything for free. They don't get it. These are the type of people that hear about universal health care and want to shout it in the streets. I don't think they will have that warm and fuzzy feeling about it while sitting down at Denver General along with the crack addicts, drunks and prostitutes.

 

[STIBROKER]

is was an HSA plan wasn't it.....

 

[BKrocko]

No. It was not an HSA, just a 5K ded 100% after ded. (max 3). We looked at lower ded's, 80/20's etc back then but they liked the premium on the 5K and understood the max 3 family members.

Question: I told him to call the hospital/cardiologist and negotiate the $2100 bill. What is a reasonable offer for him to make?

 

[STIBROKER]

at this point $25 a month......I know John is all HSA but this is the power of copays.....

 

[BKrocko]

Sorry STI - I should have stated that it is a World 5k/100% co pay plan - $35 co pay. Has a $500 ded/member Rx but the accident plan has a Rx discount card to use in the meantime. Policy also includes discount card for vision, hearing and dental included. Child wellness (shots) is also included in policy as well as other state mandated benefits. It is a good plan.

Someone told me that he should send a first payment in of $25 and write on the check "1st mth payment". If they deposit the check, they legally have agreed to accept $25/mth. I'm not looking to cheat anyone but I just can't see a hospital or doc agreeing to that low payment. I know that you (STI) have done it in the past but that was a while ago. Don't know if it will still fly. I was thinking that perhaps an offer of 60% or something but again, I don't know what is reasonable.

 

[J.R.]

Sorry STI - I should have stated that it is a World 5k/100% co pay plan - $35 co pay. Has a $500 ded/member Rx but the accident plan has a Rx discount card to use in the meantime. Policy also includes discount card for vision, hearing and dental included. Child wellness (shots) is also included in policy as well as other state mandated benefits. It is a good plan.

Someone told me that he should send a first payment in of $25 and write on the check "1st mth payment". If they deposit the check, they legally have agreed to accept $25/mth. I'm not looking to cheat anyone but I just can't see a hospital or doc agreeing to that low payment. I know that you (STI) have done it in the past but that was a while ago. Don't know if it will still fly. I was thinking that perhaps an offer of 60% or something but again, I don't know what is reasonable.

What kind of tests were run w/ the cardiologist????

I always start at 50% for a lump sum payment or monthly payment plan.

 

[BKrocko]

Thanks Salpro - I don't know what type of test were run. He will fax me a copy of the bill/EOB soon. I will watch the replies for "reasonable amount" but a 50% lump sum payment would sit well with the client. I also understand that some doc's/hospitals will dig in their heels and not negotiate.

 

[Bob_The_Insurance_Guy]

Always

Always

Always

Put the kids on a BCBS copay plan, and the husband and wife on a high deductible plan, separate from the kids. Kids go to the Dr. more frequently than adults do.

You might even separate the spouses, depending on medical history.

If the wife is more comfortable with copays, put her on a copay plan, with 3 or 4 dr. visits on it. Pu the hubby on a HDHP plan, all by himself.

It doesn't matter how much you educate them. If they want to wriggle out of something, they will suddenly get the "stupids". And they'll blame it on you. They probably had a bad month, financially, and were trying to figure out what to cut out of the budget for that month.

 

[somarco]

Someone told me that he should send a first payment in of $25 and write on the check "1st mth payment". If they deposit the check, they legally have agreed to accept $25/mth.

That "someone" is passing around an urban legend.

If they have a MC or Visa, put it on that rather than nickel & dime-ing the doc.

Even then it will be less expensive than a lower deductible plan with copays & all the bells & whistles.

Last time I had a client complaining about their high deductible plan "didn't pay anything" I gave them a price for the plan she wanted.

She really could not afford another house payment so she opted to stay where she was.

Too bad, I was looking forward to collecting the commission on the $1300/month premium.

 

[somarco]

call the hospital/cardiologist and negotiate the $2100 bill

If these were par providers there is no negotiation. They have already agreed to "discount" their rates. You can certainly ask, but my guess would be the provider will tell them to pound sand.

If they are non-par providers I know they will tell them to pound sand.