HealthMarket

[Crabcake Johnny]

Had a client get balance billed $8,000 from a shoulder surgery. Insurance company claimed the ass't surgeon was not in network. The insurance company simply checked their network, saw he wasn't listed and simply balance billed him. Turns out he was a hospital staff doctor and since the hospital was a network hospital by default he had to be in-network. Insurance company reversed their decision and paid the claim in full. I did all the research - the insurance company refused to.

Had another client have an accident and he bought the accident protection for $5,000. Claim got declined. Turn out he sent in the EOB that he got from the insurance company, but that EOB doesn't state if the claim was an accident or not. You need the original claim and EOB from the hospital - which I got and faxed to the company. Claim got paid.

You can go a lot if you care.

 

[James]

Okay, billing issues is a useful aid, just curious as how far some claims would go this time.

 

[NHB_MMA]

Oh I am certain this is from their PR dept. None of the information is surprising, but it is interesting none the less.

Nobody that knows their stuff would ever promote those companies, so I'm sure it's a PR scheme too.

 

[somarco]

James, the ONLY reason one buys health insurance is to get their claim paid. Most consumers, and agents alike, have no clue how to challenge a claim denial. When a claim issue is at stake, that is when an agent REALLY earns their commission.

Consumers fail to understand & appreciate that point which is why so many of them buy direct or from an agent who has less than 6 months in the business.

 

[James]

James, the ONLY reason one buys health insurance is to get their claim paid. Most consumers, and agents alike, have no clue how to challenge a claim denial. When a claim issue is at stake, that is when an agent REALLY earns their commission.

Consumers fail to understand & appreciate that point which is why so many of them buy direct or from an agent who has less than 6 months in the business.

Never-the-less, I'm sure the Insurance Carrier would argue that you work for them, as in, "not the client". Yet how can one argue with good customer service? Yet again, I could say, how does an independent agent with no support (as in one person) give good customer service if they are constantly prospecting and writing new business after they have XX amount of clients? Obviously at times this can become a pickle of a problem, with no support staff such as so many here suggest is heaven or a waste of money. Likely (along with other reasons) why many succesful agents in Health I know seek out a good Agency or puts one together to achieve good backroom support system.

 

[Crabcake Johnny]

You touched on a great topic James. The answer is you either get admin help or your new sales suffers. Either that or you simply never contact your client again after that sale which means they loose your info and anytime they hit a snag they just call the company.

I know agents who never stay in contact with their clients. They say "I rarely get a call so I assume everyone's happy." Wrong - nothing could be further from the truth.

My wife does a great deal of work for me which really helps. If it wasn't for her I'd have to hire an admin person. And if you've been at this for years and a fair portion of your time isn't helping clients with claims and renewals then:

A: You're a salesman, not an agent.
B: You're not writing anything.

 

[James]

You touched on a great topic James. The answer is you either get admin help or your new sales suffers. Either that or you simply never contact your client again after that sale which means they loose your info and anytime they hit a snag they just call the company.

I know agents who never stay in contact with their clients. They say "I rarely get a call so I assume everyone's happy." Wrong - nothing could be further from the truth.

My wife does a great deal of work for me which really helps. If it wasn't for her I'd have to hire an admin person. And if you've been at this for years and a fair portion of your time isn't helping clients with claims and renewals then:

A: You're a salesman, not an agent.
B: You're not writing anything.

That is great but my wife is busy with her stuff and as I am starting out writing health I see a serious problem coming up! Esp. now that I have decided to do more on the Voluntary Group, it becomes quite overwhelming at times. At least with the voluntary group I have a local agency that seems promising so far.

 

[STIBROKER]

many succesful agents in Health I know seek out a good Agency or puts one together to achieve good backroom support system.

define successful ......in my book if I get someones claim paid that makes me successful because I am the agent and know how their plan works....heres one from last month...was calling a block of increases to help with change forms (to make sure none of them convert to a crappy savers plan) and had a client tell me she is moving to aetna because unicare will not count her claim toward her deductible....I tell her before we start dumping plans what happened.....she was told to have an MRI so she goes to the mri place and ask's how much is this going to be...they tell here $1,600...so she heard you can get a better deal if you say you want to pay in cash so she asks and they tell her $800 ...so she takes the $800 bill and mails it to unicare and they start asking her for all these codes and she is starting to get pissed off......so I tell her that she should have let the mri place file it and would have paid less than the $800....sooooooo,,,,,I called the MRI place told them she had insurance which they tell me she did not tell them and would be more than happy to submit the claim...I lined them out with her # and who to call......after it was filed and repriced she received a check from the mri place for $528 in over payment ....its called looking out for you clients best interest not yours(yea it takes time to do but thats part of YOUR job as a health agent).....not how someone else can make your job easier ..... there are to many health agents out there that just want to make a quick buck and move on to the next sale.....not me....part of being a health insurance agent that I like is not just the sale but helping them years down the road......which leads to referrals....

 

[Crabcake Johnny]

Yes, and you'll never be able to farm out stuff like that. My wife takes care of admin work which frees me up and I have a telemarketer. This way when I'm unable to make the calls myself at least I'm still getting leads.

If I had to do all my marketing, all my admin work, deal with renewals and deal with claims it would never happen. It's impossible.

 

[cadylou]

Admin help

I'm brand new to insurance & am an independent broker who is currently a solo effort. For those of you who have admin help & telemarketing help - how much business did you have when you had to go to hiring people? I'm already seeing how I'll have an admin challenge as I continue to build my business, yet at this point, I don't have enough $$ coming in to pay anyone.

Suggestions? I'm sure many of you had this same catch 22 as you built your own clientele. I do have some general agent arrangements which provide some back office support, but as far as my own record keeping & lead generation, I'm getting a little stretched.