In your role as a broker and consultant for your individual and business insurance clients, you want to be sure you’re able to provide the personal service they want, while also doing what’s necessary to nurture a long-term relationship. If you fall short, you are unlikely to be a successful sales professional with a roster of satisfied customers who will readily share referrals that can lead to future business.
So, what should you know, and what should you focus on, so you can deliver personalized service and solutions to address clients’ needs? Below are a few ideas.
1: Know Your Carriers’ Portfolios
It’s essential you know what’s available in the portfolios for each of your preferred carrier partners. If your focus is Small Group Medical, you probably have a few go-to reliable health plans that you sell frequently. That may be supplemented by a handful of ancillary carriers for Dental, Vision, Disability, etc. Knowing who offers what is critical to finding the right solution for your customers.
The same is true if your focus is Large Group or IFP. You need to know who offers the products and services that will address your clients’ pain points, objectives, and budget. That includes understanding what plans offer the lowest and highest out-of-pocket costs, including deductible, copays, and coinsurance.
2: Be Aware of Networks and Providers
Equally important is being familiar with the health care providers that are part of each health plan’s network. Many, if not all, of your clients are likely to have a preference on one or more doctor, specialist, or hospital that they need access to in any new health plan they might consider. Staying in network will be important to minimizing your clients’ out-of-pocket costs.
3: Coverage Limitations and Exclusions
To help your clients avoid disappointment and misunderstandings, be sure you know about any policy limitations and exclusions. For example, HMOs often limit coverage to only the physicians and hospitals that are part of the HMO network; no coverage (other than for emergencies) is usually provided outside of the HMO service area. Exclusive Provider Organization (EPO) plans may have similar restrictions, although EPOs often allow self-referrals to specialists, which HMOs do not.
4: Preauthorization Requirements and Procedures
Some health, supplemental, and other types of insurance policies require pre-approval for certain services or procedures. HMOs may require a pre-authorization referral to see a specialist. Knowing and sharing this information with your clients will help them make the right health care decision for their individual or family health care needs.
5: Claims Protocols
Even if it is not voiced by your prospects or clients in advance, it will eventually be important to know the claims processes for each selected carrier and health plan. You could also be asked about a plan’s claims efficiency rating or A.M. Best financial rating for a company behind the selected plan (most often before completion of the sale).
Claims processes vary by plan type and carrier or administrator. That’s true, too, for claim appeals. The insured may file a direct appeal for claim reconsideration with the insurance company or health plan. A second appeal may be sought with help from a consumer assistance program. In California, the Office of the Patient Advocate is one resource. In Nevada, the Office for Consumer Health Assistance (a part of the Governor’s Consumer Health Advocate) offers help.
Another Helpful Tip
When you partner with a General Agent (GA), like Word & Brown, you’re able to take advantage of added support; sales and marketing tools and resources; valuable carrier relationships; a broader product portfolio; enrollment and underwriting assistance; quoting and other technology; Continuing Education (CE) courses and additional training; and often much more. Ask your Word &Brown rep for details. Or, if you’re not already working with us, call 800-869-8969 or fill out our online form to get started.
