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Don’t Be Fooled by Non-Network Providers

As provider networks continue to shrink and more non-network facilities like free-standing emergency rooms pop up, it’s crucial that brokers explain the importance of staying in network to their clients.

Most brokers do, of course. As we present options to clients and prospects, we discuss the difference between more flexible but more costly PPO plans and less costly but more restrictive HMO plans. It’s a tradeoff; some clients choose a PPO for the larger provider pool while others are willing to go through the referral process in order to get a more competitive rate. In either case, most advisors stress that the in-network benefits are far better than any out-of-network benefits that are included in the plan.


Most agents who sell group health coverage, and some that sell individual as well, create a spreadsheet in order to present the plans in an “apples to apples” format so their clients can quickly narrow down their options. While the spreadsheet can be a useful tool when comparing dissimilar plans by helping the client focus on the most important benefits, one big disadvantage of a quote spreadsheet is that it minimizes the characteristics of a health plan that differentiate it from the other options.

Do you keep in touch with prospects that didn’t buy?

Do you know what your close ratio is? What percentage of your prospects actually turn into clients? If you don’t know, it might be a good idea to start keeping track of this information. It will help you determine what sales techniques work and help identify areas of improvement.

How do you pick your CE classes?

Unless you’ve been in the business long enough to be grandfathered, you’re probably required by your home state to complete a couple dozen continuing education hours each license renewal period.

Most agents see this requirement as a negative—something they have to do instead of something they get to do. But maybe there’s a better way of looking at it. Continuing education classes can help agents keep up with changes in the industry, learn about new solutions, clarify their understanding, expand into other product lines, and gain insight into what their competitors are doing. When taking in a classroom setting with other agents, CE courses provide agents with great networking opportunities, and there are some events that offer credit not only for agents but also for HR managers, giving brokers an opportunity to invite some of their most important clients.

One Long-Term or Two Short-Term Plans?

For those who qualify, short-term health plans can be a great alternative to ACA compliant individual plans, especially now that the individual mandate penalty has been reduced to zero. True, short-term plans do not cover preventive care or pre-existing conditions, and they are not guarantee issue like individual plans are, but they do offer much lower monthly premiums than individual plans.

And now that the administration has increased the maximum length of a “short-term” plan to twelve months, with the ability to renew for up to three years in many states, individuals who use utilize health care less, do not have chronic conditions, and have a tight budget may have the opportunity to save on their health insurance one year at a time.

Preventive Care Isn’t Really Preventive

Let’s be honest—most preventive care visits don’t really prevent illnesses. When we go to the doctor to get poked and prodded during our annual physical, most of the tests are intended to determine if we already have or are susceptible to something that, without treatment, could become more serious.

Don’t get us wrong, these tests are critically important, but we think they’re also misnamed. The goal of a preventive visit is to catch things early and intervene before they get worse. Think of it like pulling a weed as soon as you see it, before it grows, multiplies, and takes over your entire yard. But treating your yard so that those weeds never appear in the first place—that’s preventive care.

Upcoming Executive Order on Price Transparency

In a recent AHCP blog post, we explained that a hospital price transparency law that went into effect January 1 of this year really does very little to help consumers better understand the cost of medical care. Instead, it simply requires hospitals to post their chargemaster data in a machine-readable format on its website. We finished the post by saying that “only time will tell how impactful this particular rule will be, but the movement towards transparency is a step in the right direction.”

Well, we’re happy to report that the government might be taking another—and this time much bigger—step. On May 29, Amy Goldstein and Josh Dawsey with the Washington Post wrote about an executive order President Trump is preparing to issue in an effort “to foster greater price transparency across a broad swath of the health-care industry.”

Adverse Selection vs. Moral Hazard

If you think back to the days when you were studying for your insurance license, you may remember learning a couple terms that are related but have different meanings. In this post, we’ll discuss Adverse Selection and Moral Hazard and explain why both of these terms are relevant in today’s health insurance environment.

Do Something with Your Time

As we enter the second quarter, this is officially the slow time of the year. The phone has stopped ringing off the wall, and you’ve settled back into your normal insurance routine. So we have a question:

What are you doing with all your free time?

If you’re not being productive, the truth is that you’re just wasting time, and we know you don’t want to do that. To make sure you’re making the most of your time, here are a few ideas about what you can do with the extra hours in the day.

Five Percent of People Have Huge Medical Bills

A recent article from Health Leaders Media summarizes the results of a global study from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. Here are a few of the findings:

  • “The United States exceeds every other nation in total healthcare costs.”
  • The average cost of an outpatient visit in the United States is nearly $500.
  • The average inpatient stay in the United States costs more than $22,000.
  • Higher utilization is observed among females during reproductive years.
  • “[G]lobally, visits per person and admissions per person increase with age, beginning around age 25 for visits, and age 50 for admissions.”
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