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!
Comment
Comment by Jason Powers on August 30, 2011 at 4:18pm Recent article that substantiates our agency's decline in revenues:
http://www.lifeandhealthinsurancenews.com/News/2011/8/Pages/GAO-MLR...
Comment by Yvonne Starks on August 23, 2011 at 12:46am TOO LONG.....so, here's ending to The Washington Examiner article below... :)
Congress will have to find some way to help these families. Congress must
also find a long-term solution to the Medicare reimbursement problem. Not to
mention the impending backlash from the millions of Americans who will be
forced to pay $38 billion in health exchange fines just because they managed
to get a raise.
And we haven't even touched the inevitable controversy and litigation that
will come when the Independent Payment Advisory Board begins making cuts to
Medicare and refusing to reimburse providers for selected procedures.
Obamacare has never been popular. It debuted with a barely 50 percent
favorable rating, which sunk to the low 40s by the time it passed, and
stands in the high 30s today.
The law is unmanageable, unsustainable, unpopular and, according to the 11th
Circuit, unconstitutional. If the justices on the Supreme Court have any
sense of mercy, they will officially put the law out of its misery and
invalidate the entire act.
Comment by Yvonne Starks on August 23, 2011 at 12:43am Thought this might be a good place to place this from The Washington Examiner....
Obamacare is already on its deathbed
http://campaign2012.washingtonexaminer.com/article/obamacare-alread...
thbed 8/22/2011 By Conn Carroll
When the United States Supreme Court examines the individual-mandate
provision of the Affordable Care Act sometime next spring, it will
undoubtedly give great weight to the text of the United States Constitution
and relevant Commerce Clause case law.
But, whether or not any justice will ever admit it, some on the court may be
hesitant to invalidate the new law because of the significant strain it
would place on an already divided Congress.
These worries are misplaced. Obamacare is already a very sick patient whose
symptoms will inevitably require major action by Congress. A Supreme Court
decision invalidating some, or all, of the law would only hasten the
inevitable.
The signs that Obamacare was never long for this world began to appear soon
after the bill became law last spring. Reports began leaking about large
employers securing waivers from the Department of Health and Human Services.
Seems many firms were considering dropping their insurance plans since their
policies didn't meet the new law's minimum annual benefit requirements.
Almost 1,500 waivers have been granted since then, covering more than 3.2
million Americans.
Obamacare's next blow came in December when Congress needed money to prevent
Medicare reimbursement rates for doctors from falling by almost 30 percent.
Earlier versions of Obamacare had included a permanent fix for the doctor
reimbursement issue, but the provision was stricken from the final bill
because Democrats were unwilling to reduce spending elsewhere in the federal
budget in order to pay for it.
The $19 billion Congress used to pay for the one-year fix in December came
from increased penalties on consumers whose eligibility for Obamacare health
insurance subsidies decreases midyear because of income fluctuations.
Then in May this year, Congress increased the Obamacare health exchange
subsidy penalties by another $19 billion. This time Congress had to pay for
the repeal of the law's 1099 provision, which would have required
small-business owners to file tax-reporting documents for almost all of
their vendors.
Fast-forward to Aug. 12, when the 11th Circuit Court of Appeals found
Obamacare's individual mandate unconstitutional. That same day, the Treasury
Department issued new regulations rendering millions of Americans ineligible
for health insurance subsidies based on a technical definition of
"affordable."
Judy Solomon of the liberal Center for Budget Priorities think tank said,
"The proposed rule would mean that many spouses and dependents who are
uninsured today because they can't afford family coverage would remain
uninsured in 2014."
Treasury promised to mitigate the problem by exempting affected families
from the law's insurance mandate. But while these families might not have to
pay penalties for violating the mandate, they still have to cope with an
insurance market where premiums will be much higher because of Obamacare's
other insurance regulations.
Congress will have to find some way to help these families. Congress must
also find a long-term solution to the Medicare reimbursement problem. Not to
mention the impending backlash from the millions of Americans who will be
forced to pay $38 billion in health exchange fines just because they managed
to get a ra
Comment by Karen Randall on August 22, 2011 at 7:30pm
Comment by Alex Poulter on August 22, 2011 at 11:43am The dirty little secret about the insurance industry is that the Federal Government has infiltrated nearly every aspect of the “Free Market” dating back to the early 1990’s when Bill & Hillary decided that taking baby steps to universal care was the only way to get there. This is already an industry that is highly socialist in many respects PRIOR to Obamacare. Kathleen Sebelius, the witch of the Midwest, has successfully partnered with BCBS more than a decade ago to plot out the foundation for a universal system. Many of the most reputable insurance companies were forced to fight ObamaCare on one side of the equation while positioning themselves behind the scenes to get any slice of the pie that they may be able to get. I remind everyone of the basic fundamental principle of health insurance. It’s purpose is to protect you from a large unforeseen catastrophic injury or illness. What it has become is a means to pay for or reimburse Americans for decades of voluntary or intentional abuses to their own bodies. In closing, I will share with you some words of wisdom from my Canadian Uncle who resides in Toronto, Ontario. The 3 best ways to avoid the Canadian Healthcare system is to eat healthy, exercise, and pray to God that you do not get sick!
Comment by Karen Randall on August 22, 2011 at 11:08am
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