January 19, 2007 by bob.

Q. I am a well educated, intelligent individual who is perfectly capable of finding the health insurance plan I want without agent involvement. Why should I pay extra to have an agent tell me which plan to buy?

A. I can appreciate the fact that you seem to be intelligent and well educated.

Someone once said, we are all ignorant, just in different areas.

While you may be quite informed in many areas, it is highly unlikely you have absolute, or even adequate knowledge in others. You may know how to drive a car, but that does not mean you know how to design & build a car.

Health insurance is a highly specialized area that balances the dynamics of risk management with price competitiveness. Any agent can offer quotes on multiple plans but few can effectively balance underwriting savvy and the ability to anticipate final offers from carriers with plan design and price point.

I have been involved in the health insurance industry for more than 30 years on a daily basis, and I still learn things that surprise me. What is available today may not be next month. I can’t imagine how difficult it is for those who only occasionally have to look for insurance.

As for agent compensation, it should be comforting for you to know you are not paying any more to use the services of an agent. The premiums charged by the carrier are exactly the same regardless of whether you go direct to the carrier, buy through an online “direct seller”, buy through a third party endorser or buy through an agent.

Given this scenario, would you rather deal direct with a carrier that can only tell you what they have to offer and cannot, or will not, tell you what their competitors offer?

Or would you like to go through an online direct seller that can only show you 15 - 20% of the plans available?

Possibly you would prefer to buy from a warehouse club or social organization that has been paid to promote a handful of products from a single carrier.

You can also deal with a knowledgeable agent who represents multiple carriers and can take the time to explain the differences in one plan over the other.

Your choice.

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January 18, 2007 by bob.

Q. I am trying to decide between policies with 2 different carriers. The plans are identical, but one will cover my medicine the other will not. Which one should I choose?

A. Sometimes self insuring makes sense. Sometimes it does not.

In your case you are currently taking 2 brand name meds that cost (retail) $160 per month. The premium difference in the two plans is $192 so you will save $32 per month by opting for the plan that does not cover your meds.

That is the easy part.

You may be able to save even more by asking your doc to consider lower priced meds, including generics.

Saving money is not the only consideration. You also need to weigh the consequences of the exclusionary rider should you have an illness that is related to your pre-ex conditions. Some riders are very limited and do not factor in collateral issues. Others are quite broad and should never be considered.

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January 17, 2007 by bob.

Q. I have applied for coverage for my wife & myself with several different companies. It takes over a month for the companies to respond and they keep losing the files that are sent from my doctor. In addition, my wife has a minor medical problem that is causing her to be rejected. Why can’t I find coverage for her?

A. There are several issues here that are creating your problems. The primary cause of the rejection is over medication. More on that later.

While you have used the services of an agent, in fact, more than one agent, your attempt to control the process is compounding the problems.

When you submit multiple applications simultaneously, as you did with 2 different agents, you have needlessly created a backlog. When carriers see a condition that warrants additional information they make a request from the attending physician for more details. In this case, it was the MVP (mitral valve prolapse) that is present in your wife.

Carriers do not solicit the APS (attending physicians statement) direct, but rather will go through a third party. In your case, the request was made through EMSI by two different carriers approximately 2 weeks apart. Your wife’s doctor responded to the initial request from EMSI for carrier #1. A few weeks later when carrier #2 made a similar request, also through EMSI, your doctor did not honor the request since they thought it was a duplicate from the same carrier.

This further delayed the process by almost 3 weeks.

The first carrier declined your wife for coverage, as did carrier #2.

MVP is a benign condition in most people that does not require medication. In your case, after reviewing your medical history as well as that of your wife, it would appear you have a doctor who is more than willing to provide a medication even when it is unnecessary. I am not a doctor, and am making assumptions based on a review of your records and conversation with you & your wife. You have had a very generous (albeit expensive) plan with low copays. As such, you have used the plan to the point of making your situation unacceptable to a carrier.

My guess is, if you were to ask your doctor(s) if some of the meds could be discontinued they would agree. Once you have been off meds (without ill effects) for at least 12 months you might find a carrier who will accept you.

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January 10, 2007 by bob.

Q. You quoted me a rate that was quite attractive based on the plan I selected. Now that I am submitting an application you are quoting a higher rate. What gives?

A. The initial rate was my best estimate based on data you provided in response to my questions. Once you filled in the application & faxed it to me, your spouse’s weight changed to a higher figure. That kicked her out of preferred rate bands into a standard rate band which is about 10% higher.

You asked how much she needed to weigh to qualify for preferred rates & I provided the range. You then asked if I can change the weight on the application before submitting to the carrier.

I cannot, nor will I do so.

A falsified application gets’ all of us in trouble. Eventually the carrier will find out the weight was misstated and back bill you for the premium difference.

Preferred rates are for preferred risks. I don’t make the rules, I just help to enforce them.

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January 7, 2007 by bob.

Q. I have a plan for my family with a major carrier and my rates have almost doubled in the last 30 months. I tried to get an HSA but was rejected. Why are my rates going up so much? What can I do about getting an HSA?

A. There are many reasons why your rates could double in that period of time but first you need to know that doubling in less than 3 years is not the norm.

The plan you have is old and most likely that block is deteriorating for the carrier. To compensate they raise rates dramatically in hopes of moving folks off that plan an on to something else. During the last 3 years you, and then your wife, moved into higher age brackets triggering another rate increase. Your children also aged beyond 18 triggering another jump.

All these things combined make the rate increases more dramatic than they would have been under normal circumstances.

As for the HSA rejection, you were turned down by a carrier for health insurance, not by a bank for the HSA. For reasons you have not yet shared, your health is creating an obstacle in moving to a different plan with the same or different carrier. Just because you have health issues does not mean the rest of your family cannot move on to another plan.

Your attempts to handle matters by yourself have resulted in frustration and rejection. What you really need is the counsel of an agent who understands the market and can point you in the right direction. Before you do any of that, you need to provide more details about any health issues that may or may not continue to be a stumbling block

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