Assurant One deductible Traditional Plan

Bob_The_Insurance_Guy · 06-24-2007, 06:37 PM

Quote:

Originally Posted by bluemarlin08

Assurant One deductible Traditional Plan

The traditional plan was identified in the topic, it was specifically what I was referring to.

Bob the insurance guy, are you referring to the TRADITIONAL plan. If so, you might be under the same impression I had been, that it was a network plan. If you had the same impression, send me a PM, I am working with Assurant to redo all policies sold as traditional plans. I confess that I should have been more thorough with this, never would have sold this plan if I had understood there was no network, hope my E&O is ok.

I sell the PPO Plan (usually PHCS). I'm not worried about my E&O.

bluemarlin08 · 06-24-2007, 06:53 PM

Sell it to any individual/couple without small children, who are not on three or more medications.

It is my top selling product. What I sacrifice in commissions,

Sorry, I thought you were responding to my question regarding one ded traditional.

BTW, didn't mean to infere anything regarding your E&O.

newmindfashion · 06-25-2007, 06:21 PM

One Deductible Traditional

Hey guys, not to be contradictory here but some of you have this incorrect. Yes, the One Deductible Traditional is any doctor, any hospital and claims are paid on a Reasonable and Customary basis. However, if the One Deductible Traditional is selected, there is a shadow network (PHCS) that is used when processing and paying claims.

So, similar to Assurant's STM, the customer can go wherever they like, but if the provider/facility was in PHCS, its good for the carrier and client as the PHCS negotiated discount is still processed. And unlike the One Deductible PPO, there is no out-of-network deductible and 20% coinsurance until the OOP maximum is met.

Now, the question is whether the premium difference is worth it on the One Deductible Traditional in return for not having an out-of-network deductible and additional OOP on OON services.

So in summary, there is a network but its not promoted so as to not confuse the customer and us.

bluemarlin08 · 06-25-2007, 06:46 PM

Are you sure about this? I talked with Assurant this morning and that is not what they told me. I hope you are right!

newmindfashion · 06-25-2007, 07:05 PM

Blue Marlin,
Assurant Health's agent support line told me the same thing they told you but in practice they're wrong. That's what they are told to say. My information comes from the claims department. Before I posted my last post I called yet again to make sure I was right.

PHCS is the underlying network but the plan is still considered indemnity.

somarco · 06-25-2007, 07:38 PM

So . . . claims are processed under the PHCS pricing scheme, not R&C. Can the provider balance bill?

BX does something similar here with their STM product but they use a different pricing scheme (higher) from their traditional PPO product. So a STM policyholder gets a break but not that much of a break.

Back to One Deductible Traditional, not sure it justifies the 70% or so rate up over the PPO plan.

If you are going to "catch a break" on the billed charges, why not go ahead any buy the PPO plan? Still can't see the logic behind selling the Traditional plan over the PPO.

Bob_The_Insurance_Guy · 06-25-2007, 08:04 PM

#2 agrees with #1

somarco · 06-25-2007, 08:31 PM

Quote:

#2 agrees with #1

I have this urge to shave my head and say "Make it so" . . .

arnguy · 06-26-2007, 05:56 PM

Still waiting patiently to find out who "Ned" is. Salpro22 never got his query answered.

bluemarlin08 · 06-26-2007, 06:44 PM

I'm Ned. I happened to meet somarco in a phone and email exchange and he dropped my name, not that I care. Had a great day today, 6 life applications and 2 HSA and one LTC. Doesn't happen everyday but when it does it is sweet. I think it is time for a much deserved adult beverage while the steaks marinate.

healthagent · 06-26-2007, 06:53 PM

That's cranking!!!

bluemarlin08 · 06-26-2007, 07:22 PM

I happen to be on a roll and the wife wants to go on vacation. I explained and reminded her of how in the past when I was on a roll, and we went out of town, I lost the momentum, we should learn from mistakes for a change.
There is so much business out there, so little time. In my 27 years I have never seen a better opportunity to be in this business.

arnguy · 07-03-2007, 05:33 PM

Bluemarlin08, great job! What is an "adult beverage," perhaps a Shirley Temple?

healthagent · 07-03-2007, 05:58 PM

Quote:

Originally Posted by bluemarlin08

I happen to be on a roll and the wife wants to go on vacation. I explained and reminded her of how in the past when I was on a roll, and we went out of town, I lost the momentum, we should learn from mistakes for a change.
There is so much business out there, so little time. In my 27 years I have never seen a better opportunity to be in this business.

I also believe this is the right place at the right time. Anyone in this biz with a lot of drive can make very good six figure income but like all "right place at the right time" opportunities I think the window is limited. I give it a good five more years before the states start messing around with some type of health care plan. I'm really trying to maximize my income so just in case the train stops I have two things I want; time and money.

The ROI on this is just stupid and the more money you spend the more you make. Small biz owners would kill for our ROI. Basically $120 invested gets me $900 in return.

arnguy · 07-03-2007, 09:48 PM

Good night and good luck! happy 4th!!

indmedins · 04-10-2008, 12:23 AM

Question: What does the following mean (from BlueOptions)?

Out-of-Pocket Maximums include the CYD amount, any applicable Copayments and Coinsurance amounts. Any non-covered charges or charges in excess of the Allowed Amount are not included.

Does the bold text mean clients can get balanced billed if they fall out of network? Lets say during a non-emergency situation where some doctors are out of network. And if the clients do fall out of network, aren't they still given a worst case scenaro on the out of network Max OOP. I see this clause in similar words in all MM policies and was just curious as to the real meaning of it. Thanks.

TXINSURANCE · 04-10-2008, 12:33 AM

Quote:

Any non-covered charges or charges in excess of the Allowed Amount are not included.

If it is not an allowable service or excess of allowable amount it does not go towards deductible. This would be on your EOB.

Non covered and excess would apply in network or out of network in my opinion there is no policy that blanket covers "everything".