Morbid Curiosity Reason Some Clients Have Issues W/ Carriers and Their Policy

[sunkarma11]

OK. Not even sure where to post this one - I have on and off exchange being affected so figured I'll just throw it out here...

So we have all had "difficult" cases - i.e. clients completing payment for health insurance via autodraft and yet still being cancelled, denial of coverage, etc. getting calls from a crying client, having to log multiple hours to find the problem in the carrier's system, get if fixed only to have to go through it again next month when **SuRpRiSe!!!** it happens again!

What I have noticed is that these challenges only happen with certain clients - individuals who are actually in need and/or are using their benefits... the clients that have no visits/no meds/no needs are smooth sailing (aside from commission payouts... but that is a completely different conspiracy theory on that one... )

It is only the most "costly" clients that seem to get canceled, dropped, refused, whatever. At least in my experience; I am beginning to believe that these folks are "flagged" in the carrier system as... oh i don't know... "users" or "high risk" or some such and the carrier system is in turn causing challenges with the policy in an effort to drive these people off into another carrier... conspiracy theory of the week here...

Out of Morbid Curiosity - what percentage of your "difficult" cases are with clients that "use" benefits vs. clients that don't??

Hoping I don't get taken out by a drone on the way home...

 

[AllenChicago]

OK. Not even sure where to post this one - I have on and off exchange being affected so figured I'll just throw it out here...

Out of Morbid Curiosity - what percentage of your "difficult" cases are with clients that "use" benefits vs. clients that don't??

For me, there is no correlation between benefits utilization and difficult cases. Problems (usually admin or billing) just happen randomly. Naturally, the people who use their health insurance the most have more benefit related questions, concerns, etc.. But that's normal.
ac

 

[sunkarma11]

ok. just curious... seemed an odd coincidence but is the same story two years running so was beginning to wonder...

 

[Yagents]

The "Cockroach" theory also pertains to clients.

If you see 1 cockroach, you know there are more nearby.

High claim utilizers may also be bad with the checkbook, or opening their mail, or be a major procrastinator, staying on EOB's, unable to use a computer to check network, forget what you talked about, etc