One of the courses included in Word & Brown’s recent, annual weeklong training and education course series, “Week of Webinars,” is Ethics: Worthy of Your Clients’ Trust.
This course is designed to educate and inspire brokers to make integrity and customer CARE (compassion, advocacy, responsibility, and education) the foundation for all ethical decisions and service to clients.
The course equips and encourages brokers to set, and consistently adhere to, a high standard of accountability and integrity for themselves and team members under their supervision.
Below are highlights from the course:
Ethics & Laws
All of us expect laws to help protect citizens from unethical behavior, but it is important to remember that laws frequently lag behind ethics. Ethical conduct includes compliance with the law, but it goes beyond not doing something that is illegal. It sets a higher standard.
Self-Check
Ask yourself if you want to live in a country in which those who prepare our good, manufacture our cars, and sell insurance do only what the law requires. Or, would you prefer they go beyond what the law requires and endeavor to act in the best interest of customers?
Legal, But Unethical, Behavior
Here are a couple of scenarios discussed during the course.
- A broker tells a client he or she will try to get an exception from a carrier.
- Later, the licensee later calls the client to say the carrier denied the exception. In fact, the broker made no effort to contact the carrier.
- Agent promises a client he or she will “make it happen” without knowing whether it is even possible to deliver on this promise.
- When trying to get a Broker of Record (BOR) letter from a prospective client, the agent stresses a commitment to integrity and exceptional customer service; however, once the BOR is signed, the client cannot get the agent to return calls.
Unethical conduct is a slippery slope.
NAHU Code of Ethics
In its Code of Ethics, the National Association of Health Underwriters (NAHU) asks its members to:
- Hold the selling, service, and administration of health insurance and related products and services as a professional and public trust, and do all in their power to maintain its prestige.
- Keep paramount the needs of those served.
- Respect clients’ trust and never do anything that betrays their trust or confidence.
- Give all service possible when needed.
- Present policies factually and accurately, providing all information necessary for the issuance of sound insurance coverage to the public served.
- Use no advertising known to be false or misleading.
- Consider the sale, service, and administration of health insurance and related products and services as a career, to know and abide by the laws of any jurisdiction, federal and state, where practiced and seek constantly to increase knowledge and improve the ability to meet clients’ needs.
- Be fair to competitors, and engage in no practices that may reflect unfavorably on yourself or the industry.
- Treat prospects, clients, and companies fairly by submitting applications that reveal all available information pertinent to underwriting a policy.
- Extend honest and professional conduct to clients, associates, fellow agents and brokers, and the company or companies represented.
Customer CARE Is Good Ethics – and Good Business
Making integrity and customer CARE integral to your client service is vital.
Compassion
As a health insurance professional, you are in the people business – and people matter. If you cannot empathize with those you serve, you are in the wrong business.
Excellent service involves both our heads and our hearts.
“People don’t care how much you know until they know how much you care.”
-John Calvin Maxwell, American Author, Speaker, and Pastor
Which Way Will You Choose?
Scenario: A small business client contacts the broker because an employee’s spouse is undergoing cancer treatment and needs a specific prescription medication to tolerate the recommended treatments. On the business’s prior plan, the copay for this medication was $50. On the new plan, the copay is $500.
Positive Difference (with Compassion): The broker listens and takes notes, then promptly checks the Explanation of Coverage and Rx formulary. After confirming the $500 copay is correct, the agent contacts GA Account Management to find out if there is any other help available.
The GA Account Manager checks with the insurance company to see if there are any exceptions for this type of scenario and researches the drug maker’s financial assistance program, so the broker can share it with the member.
Negative Difference (without Compassion): The broker sounds very sympathetic during the call and tells the employer “I’ll get right on it!” The broker gets distracted with quoting new business and forgets about this commitment for a couple of days. Finally, the broker makes a quick call to the carrier to ask about the Rx copay for this prescription, and then leaves a voicemail message for the client – after business hours to avoid having to deal with delivering bad news.
Word & Brown offers a variety of tools for brokers that reflect compassion. These include our Helpful Transition Tips for Clients and the Carrier & Pharmacy Bin & PIN Numbers, among other resources. Ask your representative for more information.
Advocacy: Insurance companies are growing larger through mergers and acquisitions. Clients need brokers to be their advocates more than ever before.
Brokers and your service teams need to be bulldogs when it comes to persistence in getting fair treatment for your clients.
Which Way Will You Choose?
Scenario: An employee of a small business client contacts the company’s broker because she is very concerned about claims denied for Applied Behavioral Analysis (ABA) therapy sessions for her son with autism.
Positive Difference (with Bulldog Advocacy): The broker takes notes and then requests the employee’s email address, so the client can sign a HIPAA Authorization. Broker also requests a copy of denied claim. While awaiting the requested items, the broker checks the plan’s Summary of Benefits and Coverage (SBC) and Explanation of Coverage (EOC), but cannot locate a reference to Applied Behavioral Analysis (ABA) therapy. The broker asks her GA for help. The GA Account Manager provides helpful information on federal and state law regarding ABA therapy. Once the HIPAA form is received, the broker and Account Manager call and ask for a carrier Medical Director Review of denied claims citing federal and California law. If the claim denial is not reversed, the broker/Account Manager will assist the employee with a complaint to the California Department of Managed Health Care (DMHC).
Negative Difference (Self-Service): The broker listens for a while, then as soon as the employee pauses for a moment says, “I’d really like to help, but there isn’t anything I can do. Because of HIPAA law, I don’t have access to your information. You’ll have to call the carrier’s claim department. Here’s the number. I hope everything works out.”
Because of the broker’s failure to serve as an advocate, this understandably worried mother must take time from work to make calls to advocate on behalf of her son and keep unpaid claims from going to collections, which could ruin her credit.
The California Department of Insurance website offers a variety of client advocacy resources:
- General page: http://www.insurance.ca.gov/01-consumers/101-help/
- Independent Medical Review page: http://www.insurance.ca.gov/01-consumers/101-help/Independent-Medical-Review-Program.cfm
- Consumer Complaint Center page: https://cdiapps.insurance.ca.gov/CP/login/
Reliability
Reliability is honesty in work clothes – what you do when performing your daily responsibilities. You say what you’ll do and do what you say. Don’t over-promise and under-deliver. Your words and actions should align.
Self-Check: If your words were a bridge, could your clients safely place the full weight of their trust in those words?
Which Way Will You Choose?
Scenario: A young agent, just recently issued a license in California, begins a new job at an
agency focused on selling small business health insurance. He or she wants to be successful. The broker gets an opportunity to speak with a small business owner who asks for an employee benefits quote and shares information on health care providers employees want to keep under the new plan.
Positive Difference (Reliable): When a prospect asks a complex question, you listen and take detailed notes. Rather than “fake it,” you ask for 24 hours to do some research. You request assistance from an experienced co-worker or your GA to find the best plan to fit the needs expressed by the employer. You learn from your mentor and apply information received to your current request – and to your next sales opportunity.
Negative Difference (Unreliable): You think experienced agents are exaggerating about the “learning
Curve” and getting too involved in details when serving clients. When prospects or clients ask a complex question, you give them an answer that sounds good and seems to satisfy them. You run quotes focused only on rates, ignoring provider network and Rx concerns expressed by the employer.
“No man has a good enough memory to be a successful liar.”
-Abraham Lincoln, 16th U.S. President
Education
It is essential that you help educate your clients. They cannot make good decisions concerning their health coverage if they do not fully understand the terminology used by you (and carriers) in explaining their potential or existing benefits.
Ethical brokers take their responsibility to educate clients seriously and provide information clients need to make well-informed decisions. Principled brokers take the time to break down complex topics, so clients gain a better understanding of unfamiliar concepts.
Scenario: Client contacts broker to notify her the small business has grown from fewer than 10 employees to more than 20 workers. Is there anything the company needs to do at this point?
Positive Difference (Ethical Conduct): Broker contacts his or her GA to find out what is the next step in this situation. GA Account Management sends broker information on how to count for Cal-COBRA versus federal COBRA. Broker forwards information to the client and verifies group is 20+ employees, requesting a letter from client as documentation. That information is shared with carrier on behalf of client. Now, COBRA beneficiaries will pay 102%, rather than 110% of premium, AND they will be able to continue ancillary plans that are COBRA eligible (but not Cal-COBRA eligible). Two examples are Dental and Vision.
Negative Difference (Unethical Conduct): Broker says, without checking to make sure, “No problem! It’s business as usual.” Because of the broker’s failure to take the appropriate next steps, Cal-COBRA beneficiaries will overpay for coverage and be denied the opportunity to continue ancillary plan coverage. If the plan beneficiary becomes aware of this, it could result in an audit with penalties plus civil lawsuits for the employer – and a business for the broker.
The California Department of Insurance website offers a variety of client education resources:
- Health Series Guides
Federal educational resources are also available at HealthCare.gov, including the Glossary of Health Coverage and Medical Terms.
To access the Glossary of Health Coverage and Medical Terms for California carriers, go to Word & Brown’s web page here. Ask your Word & Brown rep about other education resources, including Your Guide to Health Insurance Topics and Medical Terms.
If you are interested in the full CE Course, Ethics: Worthy of Your Clients’ Trust, check the schedule of your local health underwriter association. Word & Brown Compliance team members routinely present at regional events across California throughout the year.
