Why Do Agents Push Anthem BC/BS Over Others?

bobboatbob · 02-21-2009, 01:59 AM

I am in New Hampshire and have spent quite some time on this forum. When I started shopping for individual insurance and saw the ultra-low cap of 2K per year on Rx with Anthem I was quite surprised by that. However, Anthem, agents, and just about everyone breeze right over it and act like I'm from Pluto when I question why it's so low. So I come here and I see REAL agents talking about how crazy this is. Ok... so I'm not from outer space.

I wonder why the 3 agents I spoke to all pushed Anthem. Even though Celtic and Assurant are offered in New Hampshire and apparently do not have caps (learned that from this site). Do agents make more if they push Anthem? Does it maybe come down to customer service with Anthem being better than the rest (thus less likely for consumer to call agent when things dont go well).

The Anthem plan sounds wonderful EXCEPT the HUGE EXCEPTION being the Rx 2K per year limit. Unlimited lifetime maximum on most everything else though.... interesting. I assume the thought process on that one is when you get very sick you'll need lots of meds and thus will drop the plan before ever coming close to a large lifetime amount for other services.

I was hoping some honest agents here can share your thoughts on why you think the agents here are pushing Anthem so hard.

somarco · 02-21-2009, 07:52 AM

The truth is, most agents you will encounter are lazy and brain dead. It is easier to push a "brand name" than to explain the differences in plans from carrier to carrier.

I don't work the NH market, so I have no idea if BX pays more or less than other carriers. I do know that, in most markets, of the 3 carriers you list the comp (from hi to low) is usually Assurant, Celtic then BX.

Personally, I never offer plans with Rx caps or plans that only offer a discount Rx card. I have way too many clients who are "chronically healthy" as a result of popping pills for cholesterol, HTN, anti-depressants. Many of these have meds that run $500/mo for the total.

Then I have those who truly are sick and can blow through $2k on one dose of medication.

But to be fair, there are a lot of misinformed agents, and prospective clients, who have no clue how much treatment (including meds) truly costs. I have prospective clients tell me they just want hospitalization because they can handle the small stuff, it is the hospital bill that concerns them.

OK, but did you know that half of large claims (xs of $50k) paid by carriers are for charges incurred OUTSIDE the hospital? Once you are discharged from the hospital, in many cases you are not completely healed. There are ongoing doc visits, Rx, therapy, etc.

Same for those who say they don't need Rx cover because they don't take any medication.

Fine, but what happens if you need a cholesterol lowering drug? A 30 day supply of Lipitor is about $125; Zocor is $150; Zetia is $100 and Vytorin is $100.

But say you are on anti-depressants and need some extra help? Abilify is now being promoted as an adjunct to other anti-depressants that may not completely take care of your problem. On top of the meds you are already taking, add another $450 for Abilify. That is depressing all by itself.

Maybe you get RA (rheumatoid arthritis) and need Enbrel (which is also used for psoriasis). That's $1500 a month.

And we haven't even touched on the cancer meds, some of which run $8000 a month.

So to answer your question, any agent who allows their client to buy a plan that does not offer full Rx cover is doing a disservice to their clients.

dgoldenz · 02-21-2009, 08:37 AM

Originally Posted by somarco

The truth is, most agents you will encounter are lazy and brain dead. It is easier to push a "brand name" than to explain the differences in plans from carrier to carrier.

I don't work the NH market, so I have no idea if BX pays more or less than other carriers. I do know that, in most markets, of the 3 carriers you list the comp (from hi to low) is usually Assurant, Celtic then BX.

Personally, I never offer plans with Rx caps or plans that only offer a discount Rx card. I have way too many clients who are "chronically healthy" as a result of popping pills for cholesterol, HTN, anti-depressants. Many of these have meds that run $500/mo for the total.

Then I have those who truly are sick and can blow through $2k on one dose of medication.

But to be fair, there are a lot of misinformed agents, and prospective clients, who have no clue how much treatment (including meds) truly costs. I have prospective clients tell me they just want hospitalization because they can handle the small stuff, it is the hospital bill that concerns them.

OK, but did you know that half of large claims (xs of $50k) paid by carriers are for charges incurred OUTSIDE the hospital? Once you are discharged from the hospital, in many cases you are not completely healed. There are ongoing doc visits, Rx, therapy, etc.

Same for those who say they don't need Rx cover because they don't take any medication.

Fine, but what happens if you need a cholesterol lowering drug? A 30 day supply of Lipitor is about $125; Zocor is $150; Zetia is $100 and Vytorin is $100.

But say you are on anti-depressants and need some extra help? Abilify is now being promoted as an adjunct to other anti-depressants that may not completely take care of your problem. On top of the meds you are already taking, add another $450 for Abilify. That is depressing all by itself.

Maybe you get RA (rheumatoid arthritis) and need Enbrel (which is also used for psoriasis). That's $1500 a month.

And we haven't even touched on the cancer meds, some of which run $8000 a month.

So to answer your question, any agent who allows their client to buy a plan that does not offer full Rx cover is doing a disservice to their clients.

While these are all good points, I just wanted to interject that at least here in VA, the Anthem BC/BS Flex Choice (copay plan) and HealthSmart w/ Enhanced Drug (sort of a fusion between a HDHP and copay plan, but no copay for doctor visits) has a maximum $500 per perscription for Level 4/specialty drugs with a max OOP per year of $10k. This at least gives the client a limit to their expense if they end up on the ultra-expensive drugs. It would be nice if all carriers at least had a rider to get no max Rx benefit. Unfortunately, only Humana (part of standard plan) and Golden Rule (with rider or plan 100) have unlimited Rx....but GR wants to rider everything, their rates can be on the higher side, and a lot of people's current physicians don't accept Humana which can be a deal-breaker for them.

Anthem, at least locally, has BY FAR the best customer service and agent assistance of any carrier I've worked with. The same people always answer the phone, are very knowledgable about the underwriting and products (not just reading out of the underwriting guide which I can do myself), and process requests very quickly. They give the least grief to the client about claims, DO NOT report to MIB (or pull records from MIB, which I thought was strange), and have over 95% coverage at all doctors in the state and I believe the number is close to that percentage nationwide as well. They are also the only carrier that offers 0% coinsurance at the $1500, $2500, and $5000 deductible levels on their copay plans, making their lower rates on a $2500 deductible copay much more attractive than the higher rates of another carrier who has the deductible and then another $2500 OOP on top of that before reaching the max.

Alston · 02-21-2009, 10:38 AM

In Connecticut, BCBS' compensation is only comparable to their competitors if you sell 75 or more policies a year.

The reasons I sell Blue Cross Blue Shield products includes the network, the limited exclusions and the impact of the brand name.

dgoldenz · 02-21-2009, 10:46 AM

To answer the comp question, most policies are 15% in VA while other carriers are 20-24%, so it's not a commission issue. Anthem also doesn't exclude anything unless there is no creditable coverage. If approved with creditable coverage, everything is covered from day 1. They are the only carrier that has a maternity rider and at $71/month with only a 6-month wait period, is a great one to add for younger couples. The rider covers all pre-and-post natal doctor visits at the copay rate, and the hospitalization for pregnancy is subject to the deductible and coinsurance.

CHUMPS FROM OXFORD · 02-21-2009, 11:08 AM

I can only speak about Ohio health insurance. Anthem BC has the best policy in the market (Plan 2). UHC and Aetna are very competitively priced but offer less coverage (RX caps etc...)

Most of my clients do NOT purchase Anthem BC. Being local (here in Ohio), I try to explain (in detail) the differences in plans.

In may cases, rates are the overriding factor and ultimately sway the client's choice of companies.

The Best Ohio Health Insurance Plans

IndyAgentIDTMY · 02-21-2009, 12:09 PM

I think Anthem is pushed hard here because they are a big brand name and many agents take the path of least resistance. In Indiana, Anthem is the "800lb Gorilla" as they are headquartered here in Indianapolis and have their fingers in alot of pies. Not only do they advertise like madmen, they are the biggest Group carrier in the State and have contracts with the State to administrate the Medicaid, SCHIP and the HIP (Healthy Indiana Plan) plans as well.

As far as the benefits offered in their IM products here and service, they are no better or worse than many other carriers that I work with in Indiana. I guess it depends on the clients circumstances, but with healthy, no pre-ex client, Anthem tends to be Option C.

My biggest concerns with selling Anthem locally are;

A) Getting a rep on the phone in less than 20 minutes is virtually impossible,
B) Wellpoint just recently cut 1500 jobs, which will most likely exasporate this service issue, and
C) A large hospital group here in Central Indiana is sueing Anthem/Wellpoint for large unpaid claims and temporarily cancelled their contract. Once of my clients explained how he went to this hospital and was told they are not taking any new patients who have Anthem, so we switched him to another carrier.

bobboatbob · 02-21-2009, 12:19 PM

Originally Posted by somarco

The truth is, most agents you will encounter are lazy and brain dead. It is easier to push a "brand name" than to explain the differences in plans from carrier to carrier.

I don't work the NH market, so I have no idea if BX pays more or less than other carriers. I do know that, in most markets, of the 3 carriers you list the comp (from hi to low) is usually Assurant, Celtic then BX.

Personally, I never offer plans with Rx caps or plans that only offer a discount Rx card. I have way too many clients who are "chronically healthy" as a result of popping pills for cholesterol, HTN, anti-depressants. Many of these have meds that run $500/mo for the total.

Then I have those who truly are sick and can blow through $2k on one dose of medication.

But to be fair, there are a lot of misinformed agents, and prospective clients, who have no clue how much treatment (including meds) truly costs. I have prospective clients tell me they just want hospitalization because they can handle the small stuff, it is the hospital bill that concerns them.

OK, but did you know that half of large claims (xs of $50k) paid by carriers are for charges incurred OUTSIDE the hospital? Once you are discharged from the hospital, in many cases you are not completely healed. There are ongoing doc visits, Rx, therapy, etc.

Same for those who say they don't need Rx cover because they don't take any medication.

Fine, but what happens if you need a cholesterol lowering drug? A 30 day supply of Lipitor is about $125; Zocor is $150; Zetia is $100 and Vytorin is $100.

But say you are on anti-depressants and need some extra help? Abilify is now being promoted as an adjunct to other anti-depressants that may not completely take care of your problem. On top of the meds you are already taking, add another $450 for Abilify. That is depressing all by itself.

Maybe you get RA (rheumatoid arthritis) and need Enbrel (which is also used for psoriasis). That's $1500 a month.

And we haven't even touched on the cancer meds, some of which run $8000 a month.

So to answer your question, any agent who allows their client to buy a plan that does not offer full Rx cover is doing a disservice to their clients.

Thanks for the response somarco. I wish you were in NH - I have read through many of your posts and they are very informative.

One thing I forgot to add was that in NH, the state allows "groups of 1" for self-employed (which I am). The agent's response to my low Rx cap questioning was that in the event I started needing lots of drugs I could always leave the individual plan and join a group plan which has better benefits, no Rx cap, but considerably higher premiums (like 2x or 3x more than individual).

That seems so azz-backwards to me and no wonder group insurance is expensive. Group insurance (at least in my state of NH) requires no medical underwriting. The rate is simply by age and industry. So enjoy low individual rates until something bad happens then join the group and hurt everyone. He explained examples where some women would join a group plan to have a baby then go back to individual right after.

So I guess that's a good last resort option but it seems a little shady and doesn't make much sense when there are other individual plans in place right now without the Rx cap which are pretty close in monthly premium to the Anthem individual plan with the Rx cap.

I would bet that 95% of consumers have no idea how health insurance works and just allow agents to lead them blindly.

Dave020 · 02-21-2009, 01:09 PM

All conjecture aside, isn't this a question best asked of an agent or agents licensed and selling health insurance plans IN New Hampshire? If three separate agents made the same recommendation, that might be an indication that there is a good reason IN NH to have that plan.

You question is state-specific. Only an agent who knows NH plans can really answer it accurately.

SoCalBroker · 02-21-2009, 01:46 PM

I can't speak to the specifics of your state ... but if you've been in the game long enough, you will have had the thrilling experience of a carrier deciding to depart from doing business in your state.

One of the reasons I like carriers that have big networks, and long term proven results - is that I dont want to have to ever again deal with a carriers decision to have more profitable results in IOWA vs. California - and pull the plug ... and run-off the business in my state.

At least here in CA - Anthem/ Bx has been "dedicated" to the CA Individual marketplace - not usually the lowest price, but always there.

People get sick and indi UW sure has gotten a LOT harder in the last 10 yrs ...[ imho ] I dont want a 58 yr old cancer patient with a carrier who's exiting stage left ... leaving my business owner client or family with an out of control premium - cuz the carrier is blocking off biz in run-off mode.

CHUMPS FROM OXFORD · 02-21-2009, 01:48 PM

I don't know anything about NH health insurance. But I did stay at a Holiday Inn Express a few years ago.

Dave020 · 02-21-2009, 02:14 PM

Originally Posted by CHUMPS FROM OXFORD

I don't know anything about NH health insurance. But I did stay at a Holiday Inn Express a few years ago.

What? No Net Nanny nor Spellcheck. It MUST be the weekend, Ed!

somarco · 02-21-2009, 02:19 PM

I am not so sure the OP is an agent. It almost seems like it is coming from a consumer.

Just a wag.

Dave020 · 02-21-2009, 02:21 PM

Originally Posted by SoCalBroker

I can't speak to the specifics of your state ... but if you've been in the game long enough, you will have had the thrilling experience of a carrier deciding to depart from doing business in your state.

One of the reasons I like carriers that have big networks, and long term proven results - is that I dont want to have to ever again deal with a carriers decision to have more profitable results in IOWA vs. California - and pull the plug ... and run-off the business in my state.

At least here in CA - Anthem/ Bx has been "dedicated" to the CA Individual marketplace - not usually the lowest price, but always there.

People get sick and indi UW sure has gotten a LOT harder in the last 10 yrs ...[ imho ] I dont want a 58 yr old cancer patient with a carrier who's exiting stage left ... leaving my business owner client or family with an out of control premium - cuz the carrier is blocking off biz in run-off mode.

You wouldn't be referring to any carriers specifically, would you? LOL!

The Principal left - but sold the book to Blue Cross (now Anthem)

Cigna left and dumped over 4,000 uninsurables onto, well, nothing.

Aetna left, but guess what, they hired a couple of guns from Wellpoint and came back. How nice of them! Wonder if they'll ever leave again?

Anthem Blue Cross - dedicated to CA market
Blue Shield CA - dedicated to CA market
Health Net CA - here to stay, hope they survive
Kaiser CA - ain't going anywhere

Now, wonder what UHC is planning to do with that great investment in PacifiCare (I bet that 1.2 Billion claims handing fine tasted pretty sweet!). Notice UHC has yet to add any of "their" product to the CA IFP channel. Wonder why? Heck, they sell GR conversion coverage in CA (only the conversion plan) but it is non-domiciled LOL.

TRK3031962 · 02-21-2009, 03:10 PM

Originally Posted by dgoldenz

It would be nice if all carriers at least had a rider to get no max Rx benefit. Unfortunately, only Humana (part of standard plan) and Golden Rule (with rider or plan 100) have unlimited Rx.

In VA, American Republic offers the no max Rx benefit unless you choose the premium saver plan.

dgoldenz · 02-21-2009, 03:38 PM

Originally Posted by TRK3031962

In VA, American Republic offers the no max Rx benefit unless you choose the premium saver plan.

Haven't read good things about their underwriting and service. Can't quote them on Norvax. Don't want to be captive or have production requirements. I'll pass.

bcbroker · 07-31-2009, 12:07 PM

Originally Posted by bobboatbob

Thanks for the response somarco. I wish you were in NH - I have read through many of your posts and they are very informative.

One thing I forgot to add was that in NH, the state allows "groups of 1" for self-employed (which I am). The agent's response to my low Rx cap questioning was that in the event I started needing lots of drugs I could always leave the individual plan and join a group plan which has better benefits, no Rx cap, but considerably higher premiums (like 2x or 3x more than individual).

That seems so azz-backwards to me and no wonder group insurance is expensive. Group insurance (at least in my state of NH) requires no medical underwriting. The rate is simply by age and industry. So enjoy low individual rates until something bad happens then join the group and hurt everyone. He explained examples where some women would join a group plan to have a baby then go back to individual right after.

So I guess that's a good last resort option but it seems a little shady and doesn't make much sense when there are other individual plans in place right now without the Rx cap which are pretty close in monthly premium to the Anthem individual plan with the Rx cap.

I would bet that 95% of consumers have no idea how health insurance works and just allow agents to lead them blindly.

I ran a test on NH. the Celtic plan is fine!

Bitnis · 09-15-2009, 09:07 AM

I just heard a statistic this morning that BCBS insures 87% of the North Carolina market!!!

GreenSky · 09-15-2009, 09:20 AM

I heard that Medicare insures over 70% of all seniors nationwide.

Maybe we need a new government program to compete with Medicare.

Rick

Bitnis · 09-15-2009, 09:42 AM

I just did a search and Healthreform.gov says "the largest carrier in the state" of NC has 47% of the market. This is per ...American Medical Association. (2008,2009). "Competition in health insurance: A comprehensive study of U.S. Markets: 2008 Update," American Medical Association.

I believe our state and Alabama are being used as examples of states not having enough competition. I think the same report also stated that the top two carriers in NC hold 73% of the market. It seems as though we could use some more competition. But I don't think that competition should come from the government option.