I cringe at the thought of describing myself or any one of my fellow associates in the health insurance industry as a "hero", considering we are forever indebted to the true heroes fighting in foreign land for our freedoms every single day. Perhaps "wizard" is a better term, since often times I find myself in a position where I create magical solutions to my clients' problems from thin air. No matter the term, this writing is a case FOR the Independent Health Insurance Agent. But first, a little background:
Obamacare seeks to create an online insurance exchange, where Americans can search for, evaluate and purchase health insurance policies for themselves and their families without an agent. On the surface, it seems like an exchange would provide savings and easy access to a complex industry, right? The economy is in the tank, and I can't find one friend or family member who would decline an opportunity to save money on their health insurance premiums. Over the course of the last 10 years, insurance companies have had to get creative with their benefit packages as an answer to the public outcry for more choice and lower cost, so simplifying the process sounds like a great benefit, too, right?
One solution that Obamacare seeks to utilize in its "cost savings" approach is to cut out the need for an agent to represent the buyer in the insurance transaction. Cut out the middle-man, if you will. Sounds fantastic on paper, right? If you are remodeling your house and looking for a good deal on quality carpet, you can get "factory direct" pricing. The insurance policies scheduled to be available online through the new exchange will include "carrier direct" pricing, so what's the big deal? "Quit your moaning and groaning, Jason...you can always find a new job." Unfortunately, from many of those around me, that's the response I get. It's as if the battle being waged is "cheaper insurance for 300 million citizens versus saving Jason's household income", which makes the thought of my sacrifice a little too altruistic.
The truth of the matter, is that quality Independent Health Insurance Agents (present company included) provide much more to their clients than a simple quote.
For example, in early July I received a call from a client of mine from Nebraska. He and his family were visiting some of their extended family in Kansas City for a little vacation time. While they were in town, his oldest son had a seizure. This was of grave concern, since the child had never experienced anything like this and my client considered his son to be in great health. He was seeking advice about what hospital to go to, since he was not from the area. Being a longtime Kansas City area resident, I recommended Children's Mercy Hospital, said a prayer for him and his family and went on with my day. Piece of cake...
Fast forward 2 weeks, and come to find out that my client and his family are still at Children's Mercy. After several MRI's and CT Scans, it was discovered that his son had a brain tumor. Further testing and biopsies were scheduled. The biopsy results come in, the tumor is malignant and is scheduled to be removed. During the process of removing the tumor, his son has a seizure, while his brain is exposed. The tumor is removed and he's sewn back up. During his recovery, it's discovered that something occurred during his "open brain" seizure and he had a hematoma - his brain was bleeding. Another surgery is performed to stop the bleeding and he's still not out of the woods. At this point, my client and his family have been in and out of Kansas City for the last 2 months. The boy suffered severe brain trauma as a result of the surgeries and has lost significant motor and speech skills and will now need a lot of rehabilitation. The insurance company, in rapid claims processing fashion, overlooks the trauma and only approves 20 outpatient therapy visits for his treatment. That's when I got the call.
My client, who has been a loyal client for some time, proceeds to berate the insurance company and all of their staff for not being there when he needed them most. He's going to exhaust the benefit allowed, and then wants me to move him to a new insurance company. Recognizing the emotional situation I was presented, I calmed him down by telling him to do what he needs to do on his end to start his son's rehabilitation and that I would do what I need to do to move his appeal up the ladder with the insurance company. While I couldn't promise any favorable results, I do have key contacts with the insurance company that he doesn't have.
The solution: After discussing the situation with the insurance carrier, their own medical director reviewed the file and agreed that the patient's predicament should not be subject to a standard provision in their policy, and further approved all of the outpatient rehab the doctor's asked for. The MD also assigned a new internal case manager to monitor the boy's treatment for quality of care assurance and peace of mind for the parents. Piece of cake...
Could another agent have done what I did? Absolutely, if they applied themselves and emotionally invested in their clients.
Could my client have done what I did? Through a formal written appeals process and a standard 30 day turnaround, perhaps.
Did I have to do what I did? That's the moral and ethical argument my own trade association has been battling for years.
Did I get paid to do what I did? Our revenues were cut 40% this year as a direct result of the passage of Obamacare, and the stinkin' law hasn't even been fully implemented yet. I would argue that I don't get paid to do what I do, but if I don't look out for my clients...who will? Cue the Superman theme music...
I guess that's kind of heroic...or maybe I got lucky. Who really knows? I guess we'll find out in 2014.
Spread the health!