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BROKERS MAKING A DIFFERENCE

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BROKERS MAKING A DIFFERENCE Powered By Docstoc
					         Brokers
        Making A
      Difference
                     Real Life Testimonials




www.brokersmakingadifference.org
B R O K E R S                    M A K I N G                       A       D I F F E R E N C E




Table of
contents

Individual Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
    Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
    California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
    Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
    Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
    Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
    Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
    Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
    Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
    Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
    Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
    Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
    Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
    North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
    Nebraska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
    New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
    New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
    Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
    New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
    Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
    Oklahoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
    Oregon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
    Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
    South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
    Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
    Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
    Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
    Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23




Italicized text are testimonials from clients.
B R O K E R S                    M A K I N G                      A        D I F F E R E N C E




Group Market. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
    Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
    Arkansas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
    California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
    Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
    Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
    Georgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
    Idaho . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
    Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
    Kentucky . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
    Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
    Massachusettes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
    Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
    Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
    Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
    Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43, 51
    Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
    Mississippi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
    North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46, 52, 53
    New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46, 53
    New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
    New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
    New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
    Ohio. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
    Oregon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
    South Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
    Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
    Utah . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
    Virginia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
    Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
    Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64



Medicare Market . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
    Alabama . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
    Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
    California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
    Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
    Louisiana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
    Oregon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
    Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
    Texas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71


Italicized text are testimonials from clients.
                            Individual Market

I have been an individual health insurance broker since            I have stayed in this business because of the value I
1997. When I think back to how I provide continual                 place on personal relationships. Health insurance is
service to existing clients, I would have to say that there        not a commodity to be purchased online. Believe me,
is not much of a difference between the assistance                 I have plenty of clients who have come to me after
needed at the time of a new sale and the assistance re-            they tried to make this purchase on their own with
quired for ongoing service. There is of course a con-              less than satisfactory results. It requires careful study
centrated effort up front, but if you keep that client for         and evaluation and understanding that the average
the long term, many circumstances can come into play               person just does not have the time or desire to deal
that require ongoing advice and counsel. 90% of my                 with. I am certainly biased, but I can tell you that be-
clients are referrals; I do not advertise or purchase leads.       fore I was a broker, I had no real understanding of the
                                                                   world of health insurance. I had lost my group cov-
Issues such as loss of a job, changes in their current             erage, and tried to buy an individual policy. I was de-
plan, increases in cost of their current plan, changes             clined due to a health problem at the time, which was
in family/child status, turning 65, claims, billing is-            incredibly upsetting. I did not go through a broker so
sues etc. necessitate accessible and reliable assistance.          I did not know my options. Had I worked with a bro-
As independent professional brokers, our clients rely              ker, I would have gotten coverage and understood
on us to be there for them whenever they need to                   what had happened. We do serve a very real purpose
make decisions that impact their health insurance.                 and I am happy to assist people in any way that I can,
                                                                   especially after my own experience.
Here are some examples of typical service type calls:                                         —Kristine Morrissey (AZ)

A recent call I had was from a client who found himself
                                                                   Before getting back into private practice in 2008, I
in the hospital from an unexpected accident, needing
                                                                   had spent the prior 15 years as an executive with
insurance information that he was not in any position
                                                                   some of the nation’s top insurers. During that time, I
to deal with at the time. The call before that was from a
                                                                   had spent considerable time and energy pushing
client whose son needed assistance in upgrading his in-
                                                                   agents and brokers to sell to the uninsured, indicat-
surance plan. Another call was from an older client who
                                                                   ing it was an opportunity as well as a responsibility. In
was very insecure in purchasing insurance and had a
                                                                   my short tenure back into private practice, I have fo-
question about her recent bill. Another call was from a
                                                                   cused on the uninsured. A full two-thirds of the new
frantic young woman wanting to know what to do be-
                                                                   group business written in the last 10 months was ei-
cause she had not paid her premium and the policy was
                                                                   ther previously uninsured or due to lose coverage.
cancelled. I was able to get it reinstated.
                                                                   We can do well by doing good. The macro numbers
The health insurance industry is in a constant state
                                                                   are nothing more than a compilation of all the little
of flux. What was a perfect option at the beginning
                                                                   micros we encounter every day. The bottom line is
of the relationship with a client can change quite
                                                                   this: We can make a difference.
dramatically down the road. If you think of a stock
                                                                                             —Brian T Sullivan (CA)
broker or financial advisor, it is easy to see the need
for ongoing servicing. As an insurance broker, the
circumstances and relationships are quite similar.                 I do not know how anyone thinks that the general
This is a complex product that takes time and edu-                 public can easily choose from and understand the
cation to make the best choices and those choices                  complexities of the different health plans and line of
may need to be changed at any time.                                health coverage that are available. Our client base so
                                                                   appreciates the service that we provide to them that

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we have often heard, “We cannot do this without             It is a fact that the majority of consumers are not in-
you” and “You cannot die until I do because I would         surance experts, and they need to have someone
not know what to do without you.” We receive                who is on their side to help them figure out the com-
thank you notes, flowers, referrals etc. based on the       plicated terms and conditions of insurance products,
services that are provided by my office. The public         not only during the buying process, but when they
is inundated with so much information they need a           have to use the benefits of the policy.
professional to work through these issues for them.
Additionally, many people are not internet savvy and        We help our clients on the regular basis to under-
thus are unable to research these kinds of issues on        stand and communicate with insurance claims de-
their own, especially seniors with Medicare Part D.         partments and providers to get their rightful benefits.
                                                            We are sure that without our help, many of these
Brokers provide a very valuable service to the pub-         clients will have to pay hundreds or thousands of
lic in obtaining and informing clients of the health        dollars more out of their pocket, or waste several
coverage that is best suited for them.                      more hours of their time to get their rights protected.
                        —Barbara McClaskey (CA)
                                                            If consumer protection is a factor in any health re-
                                                            form, then there is no better way to protect the con-
I just hung up the phone with a mother in Idaho
                                                            sumer than to have experts on their side. It is true
who was crying over the cost of insurance and by
                                                            that brokers make commissions on writing health in-
the end of our conversation, she had hope for her
                                                            surance policies, but they earn every penny of that
family. For this, I say thanks!
                                                            money in helping the consumer to choose the most
                                                            competitive health insurance policy, and helping them
The information provided through The Education
                                                            get their rightful benefits during the claims process.
Foundation has been the saving grace for many of
                                                                                            —Vic Vartanian (CA)
our clients this year. In my 20 years of doing busi-
ness in our industry, never have I visited with so
many people who are not covering dependents be-                Jane had been insured with us for more than
cause of job loss or simply the cost.                          two years. She and her husband had moved
                                                               to Arizona and started a small business. We
Long story, short: A colleague of mine had a 31-year-          had been their agents from the beginning. One
old future son-in-law hospitalized and needing a               day, Jane called to say she had submitted for
quadruple bypass with no coverage. We provided                 pre-approval for an expensive medication
information and secured help and the person was                ($15,000 per treatment) and it had been de-
relocated to a hospital that would render care based           nied. I spoke to her and researched the issue.
on this assistance. The cost share was still 40% and           It seemed clear that it was medically neces-
more than the patient thought he could afford on a             sary and had been recommended by Mayo
$15-per-hour job. End result: the patient actually             and two other reputable medical providers. I
received the care needed, although the first and sec-          felt it must have been an oversight and sub-
ond treating small local hospitals had surgeons re-            mitted an appeal.
fusing to treat based on the fact the person had no
coverage. We truly saved a life!                               The appeal was denied and now Jane was be-
                                                               coming critically ill and was told she might
You are a pioneer in our industry and I personally             not live without the treatment. I got a HIPAA
want to say thanks to NAHU for making my life a lit-           release and called the chairman of the board
tle easier! You’ve made a difference in our industry           at the insurance company. I explained to them
but more important, in the lives of many.                      the concept of choosing the hill you really
                                 —Tomi Winn (CA)               want to die on and that this was not that hill. I
                                                               received a call from the CEO’s assistant telling

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   me the treatment had been approved and that               A client of mine referred Todd to me for help. As a
   Jane should begin immediately. Jane is alive              sole proprietor, Todd has an individual plan for him-
   today, two years later, and [she and her hus-             self and his family. A medical condition shared by him
   band] are still clients of ours.                          and his son is kept under control by extremely ex-
                                                             pensive home injectables and with the current eco-
As I was curious, I asked the assistant why the treat-       nomic landscape, they weren’t sure what to do. Once
ment had been denied. She told me the original re-           we understood their pharmaceutical needs, the key
quest had been denied as the treatment was not seen          was in determining an allowable plan transfer with
as being efficacious in this situation. The appeal had       the lowest out-of-pocket maximum that had the same
been sent to a physician who turned out to not be            drug coverage as his current plan. With some expla-
qualified and he had used information that was sev-          nation and after walking him through numerous sce-
eral years old. When I had called, I had included re-        narios, Todd came to understand that the solution
search that was recent and addressed the best new            was an HSA-compatible plan. The plan transfer was
treatment for her condition. They had changed                not a simple one, however, because the coverage for
claim procedure, fired the outside consultant and            his complex treatment plan could not be easily de-
moved the claims supervisor to a new position.               termined from the scant benefit summaries and mis-
                                                             interpretation was simply not acceptable. On many
This was a quality company that had not updated              conference calls, even at a supervisory level, our de-
procedure. This was not a malicious mistake and              tailed questions baffled the carrier’s service and mem-
they did the right thing. My staff made the differ-          bership department, but with persistence and
ence when they did the research and stayed with the          attention to detail, the results were quite rewarding.
claim. Had this been Medicare, Jane would have                                                    —Jeff Bader (CA)
died while waiting for them to answer the phone,
let alone dealing with the claim issue.
                                                             Jeff,
Good agents make a difference every day in the real
                                                             I just called Blue Shield to confirm they got the plan
lives of people. I tell people you might buy a car you
                                                             change. They got it and told me the transfer was ap-
need to get rid of, you might be in a marriage you
                                                             proved and will take effect May 1.
have to dissolve, you might own a home that needs
to be destroyed, BUT, if you buy the wrong health
                                                             While I was on the line, the agent confirmed that every-
insurance and then you get sick, you had better
                                                             thing in 2009 applied against the deductible and the plan
hope the insurance and the agent you chose work
                                                             will be transferred. So, that is very good news.
for you because you will not be able to move.
                                  —Bill Weaver (CA)
                                                             Thank you for all of your help. I know we had compli-
                                                             cated insurance needs to navigate—but you figured it
Yesterday, I had an 84-year-old woman in my office           out for us—and I expect the plan change will save us
who lost her husband two months ago. She came to             anywhere from $8,000-12,000 per year.
me looking for a policy through Secure Horizons.
Turns out she had a group plan with Secure Hori-             Stand ready; I will be giving your name out to everybody
zons through her husband’s employer that was bet-            I know.
ter than what I could offer. However, through errors,                                              TODD G. (CA)
she was un-enrolled. We spent an hour on the
phone with Secure Horizons and put her back on
her group plan. She wanted to pay me for my time,
but I told her to just refer me to her friends.
                              —Anthony Halby (CA)



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I have been in the insurance business for 27 years           5. I emphasize personal service, as opposed to
and have been an independent broker for 11 of                   buying insurance online. Each client or
those years. I left the “corporate world” to focus on           prospect receives a personalized comparison of
helping people with my knowledge, empathy and                   the plans I recommend, after LISTENING to the
professionalism. I hope I have succeeded on all                 client’s needs and wants. After the sale, I proac-
counts. I’m proudest of the fact that, in 11 years, I           tively seek out concerns and issues, rather than
have not lost one client due to poor service. I have            waiting for the client to contact me.
built my practice around referrals of prospective
clients who were too small or inconsequential for            6. Just because a person is no longer my client
many brokerage firms.                                           (business closes, he gets a job and drops his in-
                                                                dividual policy, etc.), doesn’t mean that I cease
Here are some of the ways I “go the extra mile” for             being his/her advisor. I welcome contact from
my clients and for many folks who will never be a               former clients and am always happy to help.
client (at least from the perspective of my being paid
for assisting them):                                         I hope these are at least small examples of how I, as
                                                             a broker, make a difference.
1. I spend LOTS of time helping folks who I know                                             —Paul Berteau (CO)
   will not qualify for any policy that will pay me
   a commission. Typically, they have one or more
                                                             Penny has been a big help to me as I have had to navi-
   health challenges and are just looking for guid-
                                                             gate the realm of health insurance. She took the time that
   ance and empathy and an understanding of
                                                             was necessary to help me understand my choices and to
   their options. I have a chronic health condition
                                                             get all the paperwork done. She is also very friendly and
   and am uninsurable, so I have a high level of
                                                             enjoyable.
   empathy. I estimate that I spend about 15-20%
                                                                                                  —Tracee K. (CO)
   of my time helping folks in these situations.

2. Recently, I have helped lots of individual                Penny was a pleasure to work with for my health insur-
   prospective applicants understand the COBRA               ance needs. She knew all of the ins and outs of insurance
   subsidy and take information back to their for-           coverage in Colorado and helped me—even with my
   mer employers and/or brokers. These are not               complicated health history—obtain coverage. Penny im-
   my group clients; I do this because it is the right       mediately responds to e-mails, and with great detail. She
   thing to do.                                              is always patient and willing to answer my questions,
                                                             Penny gets two thumbs up!!
3. I provide ongoing health insurance counseling                                               —Cameron C. (CO)
   to two cancer survivor support groups to which
   I belong. I have also helped members of the
                                                             As 2008 was drawing to an end, my office had sub-
   Crohn’s and Colitis Foundation with similar
                                                             mitted our last employer group health case (a client
   counseling. All of this, of course, is unpaid time.
                                                             named City of Life Church) for the year to Aetna for
                                                             processing and would be closing our offices for the
4. I ALWAYS work late and/or work weekends, to
                                                             New Year holiday. The underwriting seemed to be
   try to make sure that folks have insurance in place
                                                             moving very slowly, as it usually does this time of
   before a given deadline; trying my best to keep
                                                             year. We hoped to have final approval by the end of
   anyone from being uninsured for even one day.
                                                             the first week of the New Year. Little did I know that
                                                             one client would begin the year by completely
                                                             changing my life.




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                              I N D I V I D U A L         M A R K E T



On January 2, I received an urgent call on my         After David had the tests, and the surgery, I received
cell phone—a cry for help from a parent of a          a call from his father thanking me for saving his son’s
City of Life Church employee. A very rare, very       life. The surgeon told David’s family that if he had
large cancerous tumor had been found in the           not had the surgery Thursday morning, he would
chest of their 25-year-old youth pastor, David,       likely not have made it. The tumor had begun filling
who was also an expectant father. The son             with blood and could have burst at any time, ren-
was to be flown to Cook Children’s Hospital in        dering the surgery useless.
Texas for testing and surgery at the beginning
of the week. How could I expedite the group’s         As it turns out, David has a very rare form of can-
approval?                                             cer (one of forty cases the world over) and he will
                                                      need specialized chemotherapy and treatment to
Remember, the case was still in underwriting.         fight this disease.
Going through the normal process, it would
take at least another week for finalization. I        Without the entire Aetna team moving mountains
e-mailed my manager that urgent help was              to make a difference in a family’s life, this story
needed—it was New Year’s weekend! By                  would have had a much different ending. I no longer
early Monday, January 5, my manager had               see myself as just a health insurance agent—I am a
spoken with the underwriting manager urg-             humanitarian.
ing the necessity to have the group approved                                       —Tanya L. Burns (FL)
today. By early afternoon, the client was ap-
proved. Within the first few working hours of
                                                      This past Friday, an employee of our group client
the New Year, the case had been approved, is-
                                                      could not get his needed medications at the pharmacy.
sued a group number and the young pastor
                                                      Despite the Pharmacy Benefit Manager being closed
had a member I.D. number.
                                                      for the holiday, my staff was able to work with the
                                                      pharmacists on a resolution so he was able to get his
That afternoon, I received a call that special
                                                      prescription. Had it not been for the broker, the mem-
tests were needed before the Thursday morn-
                                                      ber would not have been able to get his medication.
ing surgery. David would be flown to Cook
                                                                                          —Larry Lee (FL)
Children’s Hospital the next day and tests
would begin early Wednesday. The diagnosis
code did not allow for Aetna’s approval of the        Not only do we help with the initial sale, but also
special PET scan and MRI. I initiated a con-          with ongoing renewals, COBRA administration and
ference call with my manager and his man-             keeping clients compliant with all new governmen-
ager, Sherry, and after bringing them up to           tal regulations. We also handle billing and claims is-
date on the problem and the urgency, Sherry           sues for clients.
conferenced us in with a friend she had in
Care Management. The friend was able to ex-           I just finished a claim issue for client’s employee that
pedite his case and approved all his tests, in-       was billed incorrectly for a maternity claim. The car-
cluding the lifesaving surgery on Thursday by         rier billed for the baby’s and mother’s hospital stay
the end of the day, all while keeping me up-          separately when they should have been billed to-
dated and able to give the family just a bit of       gether. The initial out-of-pocket expense to the pa-
peace during this difficult time.                     tient was $7,000 but, when reprocessed and paid
                                                      correctly, only $3,000.

                                                      We, as brokers and consultants, do this all day long.
                                                      Our value to our clients is immeasurable.



                                                  7
                     B R O K E R S          M A K I N G             A    D I F F E R E N C E



Dear Dan:                                                        We had one client that had a heart transplant. He
                                                                 was in a hospital out-of-state and their claims person
I want to sincerely thank you for your support in estab-         came in and said you are out of your benefit…our
lishing a health savings account health insurance policy         agent called the insurance company and not only
for my family.                                                   could the client stay in the hospital as his heart was
                                                                 rejecting, but the insurance company felt so bad for
As you know, purchasing health insurance is a very emo-          the scare that they put in the family they paid for all
tional process, especially when you have young children.         the claims.
Having come from traditional employer-provided policy,
we were grateful for the time you spent with us explain-         One client sent us a thank you that said “Thanks,
ing and getting us comfortable with the value and bene-          Don, for spending the time on the phone with me
fits of a health savings account. And, as the insurance          and the insurance company to help me make in-
company combed through our health histories in the un-           formed decisions about my plan, and getting my
derwriting process, your direction and support was               health factor rating reduced.”
greatly appreciated as well.                                                                —Brooks Mathern (ID)

I am thrilled with the policy and coverage, as well as the
                                                                 Insurance Specialists have always given our family first-
cost of the premium—especially as I compared it with
                                                                 rate service. When my maternity medical bills were an
the COBRA benefits offered to me, which were three
                                                                 indecipherable mess, Brooks Mathern spent countless
times the cost.
                                                                 hours tracking down each bill and getting me the infor-
                                                                 mation I needed. This was wonderful as it enabled me to
I won’t hesitate to recommend you and the HealthLife
                                                                 spend time with my newborn instead of on the phone
Group to anyone looking for health insurance, and thank
                                                                 with the insurance company.
you again for your support!
                                                                                              ANNE MARIE G. (ID)
                                                LON C.

                                     —Dan Boaz (GA)
                                                                 Working with Insurance Specialists has been an im-
                                                                 measurable pleasure. They are extremely knowledgeable
I think the largest benefit that we bring to our clients         and prompt in follow-up regarding questions and claim
is in claims processing and being an information                 concerns. Transitioning from group coverage to an indi-
center for them. We have several clients that we have            vidual plan presented some inherent challenges for me.
helped save hundreds of dollars because of our dili-             They worked extremely hard to answer questions and
gence on getting the claims filed in a timely manner             did all the legwork on tracking down the information in
and getting them refunds.                                        a timely and efficient manner.
                                                                                                   HEATHER S. (ID)
We had one client whose baby died two days after
birth. Our claims specialist took over all the claims
                                                                 Don was a lifesaver. Right when I was about to be crushed
and got all the claims taken care of with permission
                                                                 by the fact that my baby was undergoing surgery, Don
of the client and she could grieve and not have the
                                                                 arrived at the hospital, bought me a cup of coffee, and
insurance company or providers breathing down
                                                                 helped me fill out the paperwork to ensure coverage for
her neck. That took several months because the
                                                                 my baby. His personal care and attention carried me
same tests were run on the same day and the insur-
                                                                 through an emotionally traumatic time.
ance carrier needed proof that these same tests were
                                                                                                       TRACY B. (ID)
necessary. The claims specialists spent hours on the
phone getting CPT codes and procedure codes so
the family would not have to deal with all of that.



                                                             8
                                    I N D I V I D U A L               M A R K E T



Insurance Specialists have gone out of their way to help          Here are some excerpted comments from LTCi clients:
us with all of our insurance questions. They saved us
hundreds of dollars by catching a billing error. I would          I have read and re-read your informative long letter with
highly recommend their services.                                  excerpts included below. We really appreciate your tak-
          KIRSTEN D. AND MICHAEL W. (ID)                          ing time to send us your opinion and information.
                                                                                                           CAROLYN S.

I broke my wrist skate skiing. Michelle had recom-
mended an accident policy to gap my high-deductible               What an outstanding analysis in a short time period!!!
medical insurance. She met with me and assisted me in             Thank you so much. I truly appreciate all the guidance
filling out the paperwork. This was impossible for me be-         and objectivity you put in your work. You are clearly a
cause of my injury. If I would not have this gap policy in        consummate professional and subject matter expert.
addition to my health insurance, I would be in big fi-                                                        CHUCK R .
nancial trouble due to the fact I am a photographer and
had to cancel my scheduled photo shoots.
                                                                  I really appreciate getting the facts and some idea of the
                                         JANE M. (ID)
                                                                  cost of this insurance without having someone come to
                                                                  my house. Thank you so much. I would be glad to rec-
Below is an e-mail I received this morning. During                ommend you to anyone who was interested.
my group open enrollment meetings, I frequently                                                              CONNIE C.
get questions pertaining to employees’ personal sit-
uations, not necessarily the group plan. The em-
                                                                  I am most appreciative for your kind help. I am glad
ployee [who e-mailed me] is part-time, ineligible for
                                                                  there are people such as you who obviously love the in-
the clients’ group plan and has a husband who
                                                                  surance industry because it would drive me absolutely
works for the State of Illinois. She is age 57 and, al-
                                                                  nuts (and almost did). Claude, if you ever need a Wichita
though she didn’t see the need to attend a retirement
                                                                  reference, I would be ever so pleased to give you a glow-
benefits meeting with her husband and the state
                                                                  ing recommendation. Thank you again for all your help
benefits person, I counseled her to meet with the
                                                                  and for throwing me what seemed to be a life-line when
state benefits people to understand all her options.
                                                                  I felt as if I were drowning in the ocean of Long-Term
                                                                  Care Insurance facts and figures and dos and don’ts.
First of all, I want to thank you for taking the time to
                                                                                                                  DEE O.
talk with me regarding health insurance. We met with
benefits specialists at the State of Illinois on Friday and
you were right, they will cover me with insurance —               Thanks for all of the information you have given me. It
health, dental and vision.                                        helped me in selecting the policy.
                                                                                                              GRACE W.
I was very happy I spoke with you before we went down-
town. Also, since my husband is nine years older than
                                                                  Thank you for the favor of your valued assistance.
me, I asked about coverage if he should pass on before
                                                                                                                    JIM C
me. I will get part of his retirement and the insurance
coverage would continue for me. This was something he
was also concerned about.                                         I want to say “thank you” for your time and helpfulness
                                                                  in making our decision on buying long term care.
Thanks again; it was nice talking with you.                                                                        JIM W.
Happy Monday!!!
                                      MARY ANNE R.

              —submitted by Katrin Eisenberg (IL)



                                                              9
                      B R O K E R S           M A K I N G              A    D I F F E R E N C E



Stumbling on to the web site where I connected to you was           You’re terrific!
my best step. Thank you for your timely and informative                                                           SAM C.
response to my remaining questions.
                                                                                       —submitted by Claude Thau (KS)
                                                JULIE B.

                                                                    I’ve spent 40 years helping clients with every kind of
You have hit the mark.
                                                                    issue you can imagine. Two, this week, come to mind.
                                              KAREN A.
                                                                    I spoke with the spouse of one of my insured clients.
                                                                    She mentioned, during our conversation about her
Thanks for your prompt and thorough response…you                    pharmacy coverage, that her husband was experi-
have given me some serious food for thought.                        encing some symptoms and he was reluctant to make
                                                  KEN R.            an appointment to see his physician. I asked her what
                                                                    he was taking and looked it up on the internet while
                                                                    we were talking. It turned out that the symptoms he
I heard from Toby today that your advice was invaluable
                                                                    was experiencing were very serious side effects of his
to him. I’m very grateful to you for your assistance. He
                                                                    prescribed medication. I urged her to have him get in
elected the options you recommended and added the
                                                                    to see his doctor. He called me about two weeks after
spouse’s benefit. Thanks again for taking your time to help.
                                                                    seeing his physician to thank me for alerting him. His
                                                  KEN R.
                                                                    physician had him come in right away to be seen and
                                                                    told him the symptoms were life threatening.
Thanks for all the good lessons on LTC.
                                                MIKE M.             The other call was from a distraught mom who had
                                                                    a son covered under the Healthy Families program in
                                                                    California. The son has been institutionalized for psy-
Thank you so much for your great, informational letters.
                                                                    chiatric problems while in the custody of his father.
You have really helped me in making informed decisions.
                                                                    The mother needed to provide proof that her son
                                             NANCY W.
                                                                    would be covered before the hospital would discharge
                                                                    him for travel back to the Washington, D.C., area. We
Claude, you sure came up with a lot of ways to save                 were able to provide this mother with the documen-
money on the premiums.                                              tation that she needed to travel to California to pick
                                                NEAL B.             up her son. She did not know the provisions under
                                                                    her plan that permitted him to be added to her plan.
Thank goodness there are people like you to help out as
                                                                    We don’t just write the coverage for our clients and
this is a big decision—not only money wise!
                                                                    disappear as some on Capitol Hill would believe. I
                                                   PAT C.
                                                                    personally have spent a career advocating for clients
                                                                    and helping them navigate health care resources.
I appreciate all that you have done for me, mainly educat-          During the mid 80s, I invested in establishing a
ing me about LTC, and I would be happy to have my friends           Consumer Health Resource Center in Illinois where
contact you when they are interested in your product.               we provided medical treatment searches through a
                                           RICHARD K.               research associate at the University of Chicago. This
                                                                    effort resulted in countless positive outcomes. One
                                                                    in particular was stunning.
Thank you for taking so MUCH of your valuable time ex-
plaining some of the important considerations in contem-
plating a LTC purchase and how prompt and unselfish of
your time and connections you’ve ALWAYS been for me.
                                                  RON S.


                                                               10
                                  I N D I V I D U A L              M A R K E T



   A 10-year-old girl was discharged from a psy-               This is what I do on a day-to-day basis as a licensed
   chiatric institution when her mental health                 health insurance agent:
   benefits were exhausted under her plan for the              • I assess clients’ current level of benefits.
   treatment of autism. Along with a colleague,                • I field underwrite the risk to assess what they
   we researched the latest literature and re-                     might be eligible for.
   ferred the parents to a clinician who was using             • I present the risk to all carriers.
   a new urinalysis testing protocol for the by-               • I review what the group, or individual, wants in
   products of metabolism. This clinician deter-                   their benefit package. I define what is necessary,
   mined the child was biotin dependent and                        and what is desired.
   required supplementation. We didn’t hear back               • I present offers that meet and/or exceed their
   from the parents for two years and happened                     needs.
   to see them in the parking lot of Sun-Up Farm               • I make suggestions based on my experience in
   in Barrington, Illinois, which was an organic                   the market, and with other buyers like them.
   farm. They ran across the parking lot and                   • I point out the ’pros & cons’ and answer ques-
   threw their arms around my colleague, who                       tions, until they decide what path to pursue.
   was a nutritionist and had made the referral.               • My staff and I complete the necessary enroll-
   Their daughter, who was with them, had re-                      ment materials, screen all applications for com-
   covered completely by taking 5 mg of biotin                     pleteness, and forward to the carriers.
   daily. She had caught up in school, become a                • I deliver the ‘offer of coverage,’ answer final ques-
   cheerleader and was a straight-A student at-                    tions, and have employee meetings as necessary.
   tending public school in Lake Forest, Illinois.             • I shop for my clients. I shop in a market fraught
                        —Marcia P. Friedman (MD)                   with many pitfalls they might not realize, until
                                                                   the first claim occurs!
                                                               • I then service the products throughout the year.
   We have a client who had a child that was
                                                               • I maintain E&O insurance, adequate for my
   without coverage and found out that the child
                                                                   exposure.
   had cancer. In early February, we were able to
                                                               • I maintain appointments with all “the players”
   secure her coverage and get the hospital paid
                                                                   (insurance carriers) in the market.
   in less than four weeks.
                                                               • I maintain Continuing Education for compli-
                                                                   ance with all states in which I’m appointed.
We assist companies in the day-to-day administration
                                                               • I maintain membership & participation in
of benefit programs. With all of the new laws that
                                                                   NAHU, NAIFA, AHIA, and LUTCF         .
have passed over the past 10 years, most small em-
                                                               • I’m active at the local, regional, state, and fed-
ployers do not have the money to fire a full time HR
                                                                   eral level.
professional. Benefit brokers not only help secure cov-
                                                               • I’m on the Board of Directors of my State’s Risk
erage but also help manage many day-to-day activi-
                                                                   Pool (MCHA).
ties. A good example of this is the new COBRA
                                                               • I review all new plans as they become available
subsidy and what our employers need to do to stay
                                                                   to my clients.
within the law. They do not have the time to learn
                                                               • I counsel all who present themselves to me
and wait for the government to tell them what to do.
                                                                   without any fee.
We assist them in complying with these types of laws.
                                                               I’m a professional life & health insurance agent.
Lastly, these elected officials need to understand one
very important role we play is educating our clients                                    —Harlan V. Johnson (MN)
on the plans they have and how to navigate the com-
plex health care system.
                            —James A. Milkey II (MI)



                                                          11
                    B R O K E R S         M A K I N G             A    D I F F E R E N C E



People need health care. I try never to let a prospect         The benefit I bring to the client is that I assist each client
leave without help, even if it means pointing them             through the challenges of their relative underwriting,
in another direction. My bottom line is to provide             and bring them price efficiency. That efficiency gener-
information first. If I don’t have a product they can          ates rewards for the positive events making their health
afford or because of health issues know I cannot get           insurance cost less. Examples of that reward include
health insurance coverage for them, I have resources           low relative body weight and a non-smoking status. My
with which to refer my clients.                                active analysis of the deductible/premium ratio assures
                               —Jillian Merrill (MO)           them that they do not need to pay excessive premiums
                                                               to achieve a low deductible.
This story is about a lady in my choir at church who
                                                               The result of my efforts is that these individual plans
made a comment about a large out-of-network claim
                                                               are more affordable than group plans of similar con-
she was paying and the fact she had not had any help
                                                               tent. That is just because the group plans have pre-
from her husband’s HR department with the claim. We
                                                               mium up-charges for tobacco and obesity built in
do not handle the group and in fact, the group was
                                                               for all insured.
based out of VA and we are in NC. But I have groups
we do work with in VA, knew the carrier and the plans
                                                               In summary, the insurance policies I present can re-
they offer, and how to get the best out of their cus-
                                                               ward the insured for his accountability and actuar-
tomer service department. I sat down with her, had
                                                               ial advantage with lower premiums, and an attitude
her explain what had happened and what the cost of
                                                               of not insuring what is not important to the client.
the claims were. With just a little education from me
                                                                                            —Tom Hanthorn (NE)
on how the claims process should work, coaching on
what to say to customer service and the numbers she
should call to get help right away, she was able to get           Two years ago, I received a phone call from a
the claim reprocessed and saved hundreds of dollars               32-year-old woman. I could hear the desper-
on the claim. This took less than an hour of my time              ation in her voice from the onset of our con-
but made a huge difference to this family.                        versation. She was quick to explain to me that
                                                                  her husband had been laid off and their
This one is a personal friend that is a teacher. He is            COBRA was running out in 30 days. This was
dying from cancer. We have been working with him                  a major issue because she was on Medicare
for the last couple of years during his fight, helping            through disability. This poor young lady had a
him make decisions on the medical plan options he                 terrible kidney disease, and was receiving
should be choosing, looking at his other benefits                 dialysis regularly. She was also legally blind,
and helping the family plan how to make that tran-                due to complications with her disease. As her
sition from his benefits to hers when the time comes              COBRA period was ending, she’d tried franti-
and maximize what they are receiving while keeping                cally to find a coverage solution for herself
the cost in line. He is a state employee and we re-               and her family. She had been in contact with
ceive no compensation for the help we give, but                   all of the state and federal agencies she could
have spent hours with this family advising them.                  think of, including HHS, CMS and SHIP, a volun-
                              —Teri Gutierrez (NC)                teer coverage explanation agency for Medicare
                                                                  recipients. All of these resource points told her
                                                                  she had no coverage options outside of her hus-
As an independent broker serving self-employed
                                                                  band getting new group insurance. That was not
professionals and tradesmen, I broker for many of
                                                                  happening fast enough, and may not have hap-
the major individual health insurers, each with a
                                                                  pened at all. The client couldn’t accept this. She
group of products, and with each company having
                                                                  found my name via the Nebraska Association of
a different set of underwriting challenges. I consider
                                                                  Health Underwriters website and called for help.
myself an expert field underwriter who presents the
                                                                  Upon reviewing her case, I found that one
product most fitted to the client.

                                                          12
                                  I N D I V I D U A L               M A R K E T



   company had filed their Medicare Advantage plan              the time as his income was above “poverty level,”
   in NE to accept participants under the age of 65,            but we had obtained insurance for the entire family.
   on social security, disability and Medicare. Since
   I was not licensed to sell this product, I put her in        In March of 2009, this same man came into my office
   touch with the right people at the company offer-            distraught over the fact he had been let go from his
   ing this product. After some joint explanation of            job making $70k per year and was looking for work
   her scenario, and how they filed their product,she           but did not know how he was going to afford health
   was successfully enrolled. Through all of the                insurance for his family. I advised him to go down to
   heated exchanges and tears, I realized the vast              the Human Resources office and get an application
   holes in the administration of our safety net pro-           for his son to go on Medicaid and to keep him on the
   grams. I took it upon myself to assist a fellow              Blue Cross/Blue Shield New Mexico policy until he
   human being in need. I should add, although it               was approved. Once the son was approved, we can-
   makes little difference, as I acted out of principal,        celed him from his policy, saving $50 on his monthly
   neither my firm nor myself made a single dollar              premium. We then got the paperwork together to
   on her case. However, I was proud to use my skills           complete the Low-Income Premium Program Sup-
   to better someone’s position in life. I am becom-            plemental Program application and filled it out for his
   ing concerned that this scenario will become                 wife to receive the allowed discount from NMMIP.
   more commonplace, and ultimately unsustain-                  They qualified for a 75% discount, saving another
   able, if the agent is crowded out of the solution            $201.75 on their monthly premium.
   side of health care reform.
                                   —Brian Urban (NE)            There are those who think insurance agents are all
                                                                about commission. I beg to differ. Our clients are
                                                                more than numbers; they know they can come to us
   I just finished a claim issue for client’s em-
                                                                regardless of the matter and we will help in any way
   ployee that was billed incorrectly for a mater-
                                                                we can. In the example I gave above, our agency lost
   nity claim. The carrier billed for the baby and
                                                                the “commission” by our own recommendation.
   mothers hospital stay separately where they
                                                                That is customer service at its best and I am proud
   should have been billed together. The initial out
                                                                to be a health insurance agent.
   of pocket expense to the patient was $7000,
                                                                                        —Nicole McWilliams (NM)
   but when reprocessed and paid correctly was
   only $3000. We as brokers and consultants do
   this all day long. Our value to our clients is im-           My insurance agent has been Misty Baker for over ten
   measurable.                                                  years now. The continuity in a relationship with an agent
                               —Thomas Kohler (NJ)              is very valuable. Misty is able to anticipate my needs. She
                                                                always brings me a set of alternatives when it is time to
                                                                renew my insurance. When I have had trouble with
In November of 2008, I had a man come into the
                                                                claims or other matters involving my insurance company,
office on a referral. He was transferred to the “local”
                                                                she has helped. When my son, who had a kidney trans-
Artesia office of his employer from the Texas branch.
                                                                plant and three other physical handicaps, needed insur-
His medical insurance for his family was through
                                                                ance, she found a way into a high-risk insurance pool,
Blue Cross/Blue Shield of Texas and did not extend
                                                                and then followed up with both me and the company to
to our area. We applied for coverage through Blue
                                                                see that my son was properly registered and insured.
Cross/Blue Shield of New Mexico for him, his wife
and infant. His wife was declined for coverage, so I
                                                                Misty gives me excellent service, and those services go
enrolled her into the New Mexico Medical Insurance
                                                                far beyond signing me up for insurance.
Pool (high-risk pool). The NMMIP allows for dis-
                                                                                                               JOHN M.
counts of 25%, 50% and 75% due to household size
and income. They did not qualify for a reduction at


                                                           13
                    B R O K E R S         M A K I N G             A    D I F F E R E N C E



Thank you so much for the opportunity to commu-                I work in the individual, small group and senior
nicate some of the benefits that our clients realize by        markets. I feel that I am a valuable asset to both the
utilizing our health insurance agency. As you well             client and the carrier and my clients have confirmed
know, many insureds are intimidated by the larger              this with their feedback.
insurance carriers. This feeling of helplessness leads                                        —Laura Tenney (NV)
to several major problems. First, many claims go un-
paid or unprocessed due to incomplete information
                                                               I can send you letters from a sample of my clients
or misunderstood explanations. We, as brokers, let
                                                               that attest to the “added value” that brokers provide
our clients know that we are here for these issues
                                                               not only at the time of sale, but importantly
and so many more. Second, many insureds do not
                                                               throughout the relationship- whether it is resolving
understand the language in their health insurance
                                                               contentious claims disputes, or the time consuming
policy and often neglect to take advantage of pre-
                                                               administrative tasks of enrollments, terminations,
ventive services that are offered at little or no cost
                                                               COBRA admin, changing doctors, obtaining dupli-
through their existing policies. Finally, many groups
                                                               cate ID cards, resolving billing problems, etc.
that we insure do not understand the waste of excess
insurance. We explain that working and insured
                                                               Renewals in these troubled economic times means the
married spouses should not cover each other as sec-
                                                               services of the broker are vital. In the client’s frantic
ondary insureds. I cannot list the dozens of experi-
                                                               efforts to reduce costs, not only is raising deductibles
ences that our team has had in stopping garnished
                                                               and co-pays necessary, but also educating the client
wages for unpaid claims, calling out-of-network
                                                               about health reimbursement or health savings or flex-
providers to work out payment plans and making
                                                               ible savings account is crucial. Training/enrollment
sure a prescription gets filled for a client (even
                                                               meetings in the area of consumer-directed health plans
though the pharmacist cannot verify coverage on the
                                                               are an important function of the broker.
computer). Our customer service reps become so at-
tached to our clients that many times we field calls
                                                               Also, showing the client alternative health insurance
from them for the simple questions like “Where do
                                                               plans, in an objective and impartial survey of the health
I go to get the best deal on generics?” to “How do I
                                                               insurance market, is a priceless service that the busy
seek medical advice for prenatal care?”
                                                               small business owner/administrator does not have the
                                                               time or expertise to do. The vast majority of small busi-
My brother Frank and I started our health insurance
                                                               nesses do not have a person on staff trained to deal with
agency in 1991 and I know that we have helped
                                                               these issues and with 47 million uninsured we need
thousands of clients not only save money (by con-
                                                               the services of the broker even more.
stantly shopping carriers for the best deals) but also
to lead healthier lives through our assistance in uti-
                                                               We also need underwriting reform to help brokers do
lizing benefits.
                                                               their jobs. We can eliminate pre-existing condition ex-
                         —Michael A. Caparso (NV)
                                                               clusions if we make having a qualified health plan (in-
                                                               dividual or group) mandatory. We can make universal
I am an independent agent, so I work with many                 coverage possible by offering individual or group plans
different companies. I simplify for my clients the dif-        with $5000 deductibles. Such plans can offer an indi-
ferent plan designs, the benefits, the underwriting            vidual hospital, medical, and prescription drug cov-
requirements and payment options. I help my                    erage for under $3/day, less than the cost of a big Mac.
clients, based on their particular situation and                                               —Hal Kalkstein (NY)
needs, determine what to look for in a carrier; a
health plan and a network. My carriers are unique
                                                                  The bookkeeper for a current client called me
and my clients are unique; I use my understanding,
                                                                  to ask for help with an unpaid claim that to-
knowledge and skill to match the client with the car-
                                                                  taled $600. Needless to say, she doesn’t make
rier in a mutually beneficial contract.

                                                          14
                                  I N D I V I D U A L              M A R K E T



   a lot of money and a $600 bill that is trying to            advocate for this couple. I met with the social
   be collected by a collection agency made her                worker and the head nurse on her floor—asked all
   upset and unable to sleep. I sat down with her              the questions I would want asked if it were me.
   and all of the paperwork (along with the letter
   from the collection agency) and we started to               Things have worked out fairly well. My client—who
   call the appropriate parties (i.e., the lab where           was severely disabled after the aneurysm—is now at
   billing originated, insurance carrier and col-              a local nursing home (she was initially transferred
   lection agency). It seems that the carrier had              to an LTAC). She can talk and is starting to walk—
   nothing on file showing a claim was ever sub-               when everyone thought she’d live in a vegetative
   mitted and the lab was showing that multiple                state! What a miracle!
   submissions had been sent to the carrier for
   processing. We were able to get the claims re-              I keep up with this family and still have to visit the
   submitted and processed by the carrier and as               patient and see for myself. Through excellent med-
   a result, the lab notified the collection agency            ical help, perseverance and a lot of faith, this woman
   that this was settled. Show me a public option              will probably be OK.
   that is going to assist in this type of situation!                                      —Francie Dunlop (OH)
                                 —Brian Bodner (NY)
                                                               I had a client who was pregnant with twins and con-
A 52-year-old female client needed to be transferred           fined to a bed at the hospital. Although she was not
from one hospital facility in Cleveland to a hospital          having contractions, her situation was high-risk and
at the Cleveland Clinic. They were frantically waiting         her doctor would not allow her to go home without
for approval from the insurance carrier. The client’s          a fetal monitor. The insurance company would not
husband called me on my cell phone—I was in                    allow coverage for this device even though clinical
Maryland on vacation—he was frantic about getting              outcomes were good. We contacted the manufacturer
the transfer for his wife. What could I do to help?            of the device and they were willing to give her the
                                                               device at no charge if we would forward her positive
My initial response was, “I am not really sure but let         outcome in the form of an appeal to the insurance
me think about this for a few minutes.” After some             company so that the manufacturer might possibly get
thought, I called a contact in Cleveland asking for            a contract with the carrier. If we hadn’t gotten in-
help getting the approval. Within 20 minutes, the job          volved, the claims would have been significantly
was done. As I called my client’s husband to tell him          higher, due to the fact that the patient would have
the insurance carrier would be approving the trans-            been confined to the hospital for several days. This
fer, he picked up the phone saying “Thank you!” The            would have cost the member and insurance com-
social worker at Hospital A had just gotten the call to        pany more money. This was a win/win for everyone.
move this woman to the Cleveland Clinic. He was                                            —Melissa Roberts (OK)
overwhelmed at what I did. Well, it really wasn’t me
but I did know who to call who lit the fire under the
                                                               We had a recent claim that we felt was not being paid
responsible person for giving the go-ahead.
                                                               properly. We contacted the hospital, the network,
                                                               and the carrier to figure out why and determined the
This is NOT the end of this story. My client ended
                                                               fault was with the provider. We provided them the
up having a brain aneurysm at the clinic and was
                                                               section of the certificate booklet that indicated the
there for months. There was so much red tape about
                                                               claim should be paid. After three claim payment de-
where this woman would be transferred once she
                                                               nials, we created a letter and submitted all of our
was stable. I asked a lot of questions—these people
                                                               documentation to the state insurance department.
really had no one to be a “go to” person for them.
                                                               The claim was finally paid four months later and we
The husband was a wreck over his wife’s medical
                                                               were able to save our customer $22,000.
state. I ended up going to the clinic to be an outside

                                                          15
                    B R O K E R S        M A K I N G            A     D I F F E R E N C E



   We had a situation where a customer had an                 I helped one individual who was previously de-
   untimely enrollment after a baby was born. We              clined in May of 2008 and she was able to obtain
   provided the carrier all of the steps and docu-            coverage in December of the same year. She an-
   mentation that we had regarding the birth of               swered “YES” to 5 of the 50 medical questions. I
   twins and pointed out why the insured didn’t               called her application the “book” because the total
   know he needed to complete a form to add                   pages submitted were 30 pages!
   them. We noted that the insured received a let-
   ter from them regarding the babies being born              I helped another individual who was declined and
   and that they would be monitoring their stay               then later received a waiver for a pre-existing con-
   in the hospital which is why they thought the              dition for two years and the client was “more than
   babies were added. The letter only indicated               willing” to accept the waiver and obtain coverage.
   they needed to notify their employer—it didn’t
   indicate they needed to complete a form. After             It is hard for me to accept defeat and I urge my clients
   six months of going back and forth with the                to “fight this decline.” I help them get out of the Ore-
   hospitals and carrier executives, the claim was            gon Medical Insurance Pool and on to a better plan.
   paid. This saved our customer $99,000.
                                                              My clients love me and it’s just another way that I pro-
Another customer changed carriers and was partially           vide excellent customer service. Can Oregon Health
self-funded. We had gone over the renewal with the            Authority or the federal government provide this? I
current carrier and specifically asked them how               doubt it.
much money they would owe should they change                                               —Donna R. Green (OR)
carriers. He pointed out the amount on the renewal
that would be required to be paid. The customer
                                                              As a licensed health insurance broker, my number-
changed carriers and later got a letter from the
                                                              one priority is to help every person I speak with find
previous carrier requesting payment for $150,000
                                                              affordable health care. I’ve helped many people with
more then what was on the renewal. The carrier
                                                              pre-existing conditions such as cancer, diabetes,
pointed out that the customer had signed off on the
                                                              congestive heart failure, HIV, kidney disease and MS
higher amount at the beginning of the contract year
                                                              acquire coverage through a business or a guarantee-
and that the number provided on the renewal was a
                                                              issue plan. Many Americans with pre-existing con-
typo. They failed to change the amount from the
                                                              ditions are unaware that they may quality for
prior year’s renewal. I pointed out that although they
                                                              coverage through a small business, chamber of com-
signed off on it a year ago, the renewal was released
                                                              merce association plan or a guarantee-issue plan. I
and discussed and that a representative from their
                                                              try to help people every day…and many times with-
company, in a meeting with us, confirmed the
                                                              out any compensation because I want all Americans
amount that would be due should the customer de-
                                                              to be covered regardless of race, income or medical
cide to change carriers. After executives reviewed
                                                              condition. Seniors require a lot of attention and are
the situation, they waived the additional money due.
                                                              often overwhelmed with Medicare. Who is going to
                          —Carol A. Anderson (OK)
                                                              properly advise them?

I obtain many customers who have applied for cov-             We need more properly licensed brokers and agents
erage online or directly from the insurance carrier           who understand the needs of individuals, families,
and are declined. I have a meeting with them in               students and small businesses to address our health
which we go over their application and what was re-           care issues—NOT LESS.
viewed by underwriting. I request the client to bring                                         —Joe Copson (PA)
in their doctor’s notes for each item they checked
“YES” out of the 50 medical questions.



                                                         16
                                   I N D I V I D U A L               M A R K E T



My health insurance agent company, Creative Insurance            There are many times I am needed by my clients to
Consultants, is always available to help me navigate the         help explain how their bills and EOB (explanation of
confusing options of health insurance. They are so valu-         benefits) coordinate. The phrasing between insur-
able to me and provide me assurance I am selecting the           ance companies and doctors’ offices do not always
best plan for me and my family. Creative Insurance Con-          match. It is left to the client to figure out what to
sultants work really hard to answer all my questions and         pay and what the carrier has paid.
have always provided sound advice about coverage and
policies so I am making the best decision about coverage.           Just last week, a client came in who had lost a
When my son was born, Creative Insurance Consultants                baby. They didn’t want to go over all the bills and
helped me make sure I understood how to add him to my               EOBs. It had been an extremely stressful time. I
policy, explained all the options, and helped assure me             sat down with the husband and found the dupli-
my claims were being processed correctly after his birth.           cate bills, matched up the EOB with the correct
This was a huge relief.                                             bill, and showed him what went to the deductible
                      ROBIN BLACKWOOD (SC)                          and co-insurance. He could have figured it out,
                                                                    but in a few minutes, I had him through this
                                                                    process. I felt so much better knowing that the
I have a small-group client that ranges from nine to
                                                                    bills would be paid and this part of the grief
11 employees in Houston.
                                                                    process was out of the way for the couple.
In May of 2008, the owner’s wife and two daughters
                                                                 The clients I have know they can call me at any time with
went to New York City for a weekend event that in-
                                                                 any question. My clients are not only clients, but family.
cluded the wedding of a friend of one of the daughters.
                                                                 They know I am looking out for their best interest of
                                                                 providing the best coverage at the best possible price.
While in New York City, one of the daughters be-
                                                                                        —Howard Glenn Hanna (TX)
came seriously ill and was rushed to a hospital. It was
determined that her appendix was about to rupture
so emergency surgery was performed. You guessed                  I am self-employed. Last October, my wife was in the
it…all of the treatment and care given was in an out-            hospital with pneumonia. Last November, I had prostate
of-network hospital with out-of-network physicians.              surgery. And in January of this year, my long-time health
                                                                 insurance arranged through a professional organization
The family, upon receipt of the EOB, had serious sticker         upped its rates by 150%. I went to Austin area insurance
shock. They called me after several conversations with           agent Misty Baker at Lonestar Benefit Solutions, looking
the hospital’s accounts receivable department. They              for help. Help she arranged.
owed the hospital a very large sum of money.
                                                                 From the beginning, I was an obvious Texas Risk Pool
I called the carrier and got the necessary informa-              candidate. After the insurance company Misty picked for
tion for the insured to appeal the charges. Within a             my wife found out about her recent hospital stay, she was
few weeks, my client called to thank me and say that             rejected for coverage and also became a Risk Pool can-
the carrier made adjustments in the billing to reflect           didate. Once we were both pointed towards the Texas
PPO pricing due to the fact that it was an emergency             Risk Pool, Misty helped us complete the original appli-
situation.                                                       cations completely and accurately, and followed up to
                                                                 check on the progress of our applications. At the same
I am glad they chose to call me instead of working               time she steered my daughter, not a risk pool candidate,
out a payment schedule with the hospital.                        to high-quality coverage through BCBS of Texas.
                               —Tom Cottar (TX)
                                                                 I have nothing but praise for the work Ms. Baker did. Of
                                                                 course, my wife and I were special cases, but I have
                                                                 confidence that Misty would have gotten us excellent

                                                            17
                      B R O K E R S           M A K I N G             A    D I F F E R E N C E



coverage working directly with insurance companies if              I have been in this business since 1987, and I could
that had been possible, just as she did for my daughter.           tell you dozens of stories about the service I bring to
                                                                   my clients each and every day. It makes me heartsick
Any changes to Texas or national insurance policy that             to think that what I have loved to do all these years
eliminated or weakened private insurance options and               could be taken away from me with just a stroke of
the work of people like Ms. Baker will be bad news for             some bureaucrat’s pen. In most instances, it is the
those needing medical coverage in here and possibly                health insurance broker who is responsible for
throughout the United States.                                      Americans being able to navigate the health care sys-
                                               STEVEN Z.           tem. Without agents and brokers, it will be a much
                                                                   bigger “crisis” because no one will have an advocate
                   —submitted by Misty Baker (TX)
                                                                   working for their best interests…all they will have is
                                                                   a 1-800 number to call. And we all know how ut-
I have been urged to impress upon you the value I                  terly frustrating and useless that can be.
bring to the table as a health insurance broker. I                                             —Mary J. Samudio (TX)
hardly know where to begin, but here’s just one of
dozens of stories:
                                                                   The following appeared in the Orlando Sentinel on
                                                                   November 27, 2003
   Several years ago, a group client of mine was
   dying of brain cancer. His wife and I became good
                                                                   Insurance Angel
   friends during their ordeal, sharing many small
                                                                   Special thanks to Maryann at R.W. Morgan Associates,
   triumphs as Gamma Knife procedures worked to
                                                                   in Altamonte Springs who took lots of time and received
   relieve his suffering for awhile, or his medication
                                                                   no compensation to find out if I qualified for health in-
   made it easier for him to make it through the day.
                                                                   surance. I am no longer one of the millions of uninsured
   We also cried together on many occasions as it
                                                                   in this country! What a great human being; Bob Morgan
   became apparent that he wouldn’t pull through
                                                                   is fortunate to have such a superb employee.
   after all. Throughout the two years that he fought
                                                                                                     ANONYMOUS (FL)
   such a courageous battle, she thanked me time
   and again for being there to guide her through the
   claim process and for getting her “connected”                   My story is all about a good agent. Mary Lou Hudman
   with a large claim specialist. I ended up with a file           was, for me, more than an agent. She took her time and
   almost four inches thick…filled with EOBs and                   her professional knowledge to organize and make calls for
   provider statements…all of which I personally                   me regarding my health insurance and payment of in-
   helped her understand and adjudicate when there                 voices. I commend her for doing this for me while I was un-
   was a problem with a claim.                                     able to help myself. God sent an angel to be with me at
                                                                   my time of need. I had thousand and thousands of dollars
The week her husband died, she called me late one                  in unpaid insurance claims and invoices. She called them
evening on my office line…I forward my office phone                over and over again to help clear up these outstanding in-
to my cell phone when I leave my office so my clients              voices. At the end of about 18 months, I still had a few
can always reach me. She was very upset because she                small outstanding invoices that I did have to pay-out- of
said he was struggling to stay alive and she thought it            pocket to keep it off my credit report. But without my ded-
was because he was worried that she couldn’t make it               icated agent I would have paid thousands more.
without him. I remembered hearing my pastor tell a
story about how sometimes we have to assure our                    Thank you to Mary Lou Hudman for such professional
loved ones that we will be heartbroken, but we will be             sensitivity given to me.
all right and that they can go on if they need to. I shared                                                   MARSHA N.
that with her. She called a couple days later to say that
she had talked with her husband after we talked, and
that a peace came over him and he died that night.

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                                    I N D I V I D U A L               M A R K E T



I am one of those health insurance agents on the front            months of tests, the little girl was diagnosed with a rare
line of helping families obtain coverage that fits their          chromosome disease that is progressive and terminal.
needs and their budget. I focus on the individual in-
surance market with a little penetration in the local             The mother and I had immediately formed a warm re-
small employer market. When I started my insurance                lationship at the time of the sale, and she frequently
agency nine years ago, I determined that every family             came in to pay the premium with the toddler and to
deserves personal contact with their agent, giving them           visit. After a while I noticed that she had begun to come
the ability to understand the complex options for cov-            in alone and she also paid ahead on the premium.
erage and have their questions answered. I have built             When I questioned her about this in the course of con-
my business one family at a time, meeting with them               versation, she began to cry and told me about the di-
personally in their homes and helping them through                agnosis of her beautiful child. I immediately put the
the process of choosing and applying for a plan.                  family on my prayer list and also reminded her of the
                                                                  help she could get from the insurance company’s case
In addition to the initial set-up of a policy, my clients         manager. The family was also the recipient of a cash
call me when any problem or question arises. If they              award from a charity that I am a member of that helps
don’t remember details of their coverage or if they               people who have exhausted all traditional avenues of
are having a claims problem, I encourage them to                  help. The little girl’s condition causes her to be ex-
include me and together we work to find the solu-                 tremely sensitive to any change in surroundings, and
tion. A good portion of my day is spent working                   the mother is very isolated and exhausted. She actu-
with my clients on day-to-day issues.                             ally looks forward to paying her premium and visiting
                                                                  for a moment. The policy that she is faithful about pay-
Because I do no advertising, I have depended on re-               ing is also responsible for that little girl receiving the
ferrals from my clients in order to continue to ex-               very best medical care.
pand my business. I have been overwhelmed with
support from the families I have helped as they have              Being a health insurance professional is a very re-
referred me to their friends, family, and neighbors.              warding career because of all the different people I
Many have expressed appreciation for my ongoing                   meet, and instances like the one above add a di-
help in leading them through the often confusing                  mension of caring that cannot be described.
world of insurance coverage.                                                                           —Anonymous

I believe that the agent is the most important re-
                                                                  I understand that the freedom to choose health insurance
source a family has to make sure that they are cov-
                                                                  coverage and work with an insurance agent may be
ered properly and are being treated fairly by their
                                                                  taken away from the public. Health insurance is an ex-
insurance company. I am their advocate.
                                                                  pensive and complex purchase. Over the past two years,
                          —James McDonald (UT)
                                                                  my family has had many different needs and each cir-
                                                                  cumstance required adjusting our health insurance to
There are many stories that I could tell about my ongo-           adapt to the changes. We have had to purchase more in-
ing relationships with people to whom I have sold health          surance, thus spending more money for benefits accom-
insurance. Probably the most special relationship I have          panied with additional terms. Each time we have had a
is with the mother of a toddler. The parents of a darling         life-changing event, our agent has helped us get the ben-
baby girl bought a child-only policy for her because they         efits that would fit our situation best. Each time I have a
wanted her to have access to the very best medical care.          claim, my agent personally walks me through the process
During this child’s infancy, the parents began to believe         to ensure all the proper procedures are followed to max-
that something was not completely OK with their little            imize my benefits. In addition, my agent has assisted in
daughter. The doctors at first dismissed the parents con-         billing problems and dealt personally with the insurance
cerns, but they soon began to look into diagnosing the            company on many occasions to ensure my coverage.
overall cause for the child’s many medical problems. After

                                                             19
                      B R O K E R S          M A K I N G              A    D I F F E R E N C E



I value the opportunity to choose my own insurance,                fice extremely happy that I was able to make sure that
work with an agent, and get the health benefits cus-               he would only pay $15, rather than $499.
tomized for my family. Please do not take away the right
of the public to continue choosing health benefits and             There are many examples over the years where I have
working with an agent of our choice.                               saved clients thousands of dollars per year. For exam-
                           HEATHER SCHROEDER                       ple, I’ve met perhaps 25-50 clients over the years who
                                                                   had originally signed up with a carrier directly, without
                                                                   using a broker. Five or 10 years later, they call me ask-
I started a non-profit for children with cancer over
                                                                   ing why their rates are so high—sometimes close to
twenty years ago. I have personally felt the effects of in-
                                                                   $1,000 per month. In most of those cases, I was able
surance companies and their impact when you have a
                                                                   to help the client reapply with the same carrier for new
child with cancer. Muddling through the paperwork,
                                                                   lower rates on the same or a very similar plan, or apply
EOBs, rejection and authorization for emergency proce-
                                                                   with a different carrier for lower rates on a very similar
dures is an added stress to this horrible disease. We have
                                                                   plan. In most cases, the client was able to keep the
all been blessed by Mike Kapandais of Empact Benefits
                                                                   same coverage, and reduce cost from roughly $800
in Brick Town, NJ. He offered to help any and all of our
                                                                   monthly to $500 or $600 a month. In other cases, the
families free of charge through the paperwork, phone
                                                                   client, after some analysis and advice from me as their
calls and sorting out of bills they have received. His com-
                                                                   new broker, decided to go to a higher-deductible HSA
passion, services and expertise has helped families wade
                                                                   plan and reduce monthly cost to roughly $200-$300.
through a flood of bills that has drowned them before his
                                                                   And, in some cases, I helped my client save more than
rescue. He cuts through the garbage, the long-awaited
                                                                   $5,000 per year, which over a 10 year period, would
callbacks and the verbiage that is not understandable.
                                                                   exceed $50,000 of savings.
                                     LINDA GILLICK

                                                                   I am currently the broker for approximately 650 in-
I’ve been an insurance agent for over 12 years, so                 dividual clients. Most of them are self-employed,
there are hundreds of examples of how I’ve helped                  work for a company who does not offer insurance,
my clients over the years.                                         or the insurance they are offered was more expen-
                                                                   sive than what I could find them in the individual
Just 30 minutes ago, I had a client call me who was told           market. Without the knowledge and help of an ex-
by the billing person at the hospital that his                     perienced, professional broker, many of my clients
colonoscopy was going to cost him $499. I had recently             would still be paying $800 monthly payments, in-
switched him from a plan that had a $2,500 deductible,             stead of $500-$600, or $200-$300 a month if they
with no preventive coverage to a HSA plan that did                 have switched to HSAs.
cover preventive care. Thus, when he told me that it
was going to cost $499, I wanted to verify why it was              As a testimony to the value of a long-term broker,
not the typical $15 co-pay for a preventive visit on his           consider the growth of my agency. I have used al-
new HSA plan. It would have cost him $499 on his plan              most no advertising or leads throughout my career.
two months ago, but his new plan should only cost him              I moved from Idaho to Utah, and thus knew very
$15. He called me and then came to my office. I called             few people to whom I could sell. However, I made
the hospital and verified with the billing person that as          cold calls, etc. and when my clients could see that I
long as the doctor billed the colonoscopy as “preven-              not only helped them obtain an appropriate plan
tive” that it would only cost him $15. My client proba-            initially, but also called them each year to “reana-
bly would not have called the insurance company to                 lyze” their needs, they not only stayed with me, but
question the accuracy of the $499 he was quoted, nor               they told their associates, friends and family about
did he have a sure knowledge that they were incorrect.             how much a good broker can help them in choosing
However, he trusted his health insurance agent as a true           a good plan and save money by evaluating their
professional who would serve his needs. He left my of-             needs every year. If I, as a broker, did not have


                                                              20
                                   I N D I V I D U A L              M A R K E T



significant value to my clients, I would not have the           ica functions well when we have “specialization of
retention and growth in my insurance agency. I do               labor,” which allows for true professional or experts
not have any sub-agents under me. I complete all                in every field. I hope America is allowed to continue
new sales and all ongoing service for all of my                 to benefit from experts in every field, including an
clients. It is hard to quantify exactly, but I would es-        expert to help every American determine how to best
timate that the total savings that I have provided to           handle their health insurance needs.
my clients over the years to be several million dol-                                       —Duane Andersen (UT)
lars. I hope that Congress understands the true value
of a loyal broker who continues to serve his or her
                                                                Our firm is small, but we offer a full-service package
clients in the short-term and in the long-term. I have
                                                                that includes COBRA, direct employee access to our
only focused in this letter on the savings I provide to
                                                                staff for claims resolution as well as HR support to our
my clients. This does not include help with claims
                                                                clients. These functions are ongoing throughout the
issues and other services that a broker provides to
                                                                year. We are very involved with our clients and their
his clients. If brokers are ever “done away with,” it
                                                                employees and try to get involved when they have
worries me that many clients will suffer as they ini-
                                                                claims or service problems with their benefit plans.
tially struggle to find the best plan for them, but also
I fear that they will stay on the same plan for many
                                                                   We have a 95% success rate in getting our
years, even if, over time, that plan is no longer the
                                                                   clients a favorable resolution to their claims is-
plan that best serves their interests.
                                                                   sues. Two years ago, we had one of our clients
                                                                   go the hospital and deliver a premature baby.
Many industries in America are served well by
                                                                   Our client called us to verify the hospital she
knowledgeable, experienced professionals who help
                                                                   wanted to use took her insurance. We called
their clients in a way that is hard to quantify. I hope
                                                                   the insurance company to confirm as well as
that Americans will always have the ability to call a
                                                                   the client. The insurance company confirmed
professional health insurance expert, or in other
                                                                   that they did participate with the hospital, so
words, their broker, to make sure they have the plan
                                                                   she went in to have her baby. While her baby
that best suits them from year to year. I cannot be an
                                                                   was in the NICU, she started receiving some
expert in every field, but I am an expert in health
                                                                   very large bills, which was very distressing to
insurance. I do not have the time to learn every field
                                                                   her as she thought she was covered. We called
to the point of becoming an expert, thus I rely on
                                                                   the hospital and NICU, and as it turned out, the
other experts in their chosen fields. I know that
                                                                   hospital took her insurance, but the NICU in-
most—if not all—of my clients feel the same. They
                                                                   side the hospital was an independent contrac-
do not have the time to become an expert in health
                                                                   tor and did not participate. The bills for her
insurance.
                                                                   child’s care mounted to more than $500,000.
                                                                   Our staff worked with the client, the insurance
I have spent 12 years, 30-40 hours per week (which
                                                                   company, and the NICU for over seven months
equates 18,000-24,000 hours) dealing with health
                                                                   to get this resolved. We were successful in get-
insurance issues. I hope Congress does not expect
                                                                   ting all the claims paid and/or written off, and
every American to ever spend that much time, so that
                                                                   the client ended up paying only what her policy
they would be as qualified as a broker like myself, to
                                                                   indicated. As you might imagine, our client was
truly make a fully educated, professional decision on
                                                                   extremely grateful for our efforts.
their family’s health insurance needs from year to
                                                                                               —Scott Eastman (VA)
year. I believe in the saying that no one can be an ex-
pert in all fields. You may be a “jack of all trades,”
but you will never be an expert in everything. Amer-




                                                           21
                     B R O K E R S         M A K I N G            A     D I F F E R E N C E



I have been a health insurance broker for about six             into their system. In the end, we saved her reputa-
years. I got into this business because I saw that a            tion, credit score and gave her peace of mind.
lot of people needed help with health insurance. So
far, I have helped a lot of those people obtain af-             This is the reason we are doing this job. This is just
fordable health insurance with no additional charge             one of the situations that have come across my desk.
to them. I simply offer them free, great service. With          I could tell you of hundreds of people who we have
this good guidance, they tend to be happy with their            helped before, during and after they have had their
plans and continue to keep their plans for a long               policies enforced.
time. With annual premium increases, I also help                                                  —Ulla Capps (VA)
them make plan adjustment or changes.
                                                                I have been a licensed insurance agent for 24 years.
The important part of my service is to help my
                                                                During those years, I have helped thousands of peo-
clients understand their benefits, use their benefits
                                                                ple become insured, understand their benefits and
wisely and especially straighten out their claim prob-
                                                                how to use them, as well as providing assistance at
lems. Without my help, many of my clients would
                                                                claim time. There has been a lot of change in 24
end up paying unnecessary claims. Many carriers
                                                                years. What has not changed is that people want
deny the claim payment because of some error or
                                                                their employers to decide on their benefits. The
missing information, and with my help, they usu-
                                                                American public really tunes in to their coverage
ally get paid or make adjustments in my clients’
                                                                when disaster strikes—a heart attack, major diag-
favor.
                                                                nosis, stroke, etc. Then they are interested in what
                                                                their benefits provide. Unfortunately that is when it
My clients are always very grateful for my service or
                                                                is too late. My job over the past 24 years has been to
assistance, particularly because it is difficult to find
                                                                take care of my customers. I insure them with the
the right health insurance on your own. The system
                                                                coverage that best meets their needs. I am there to
makes it very hard. People need good guidance to
                                                                help during a claim.
deal with the expensive and complicated system.
                                                                   This week I was able to insure a mother and her
I also deal with many minorities who especially need
                                                                   12-year old daughter and save them more than
my help due to a language barrier. Even though the
                                                                   $300 per month in premiums. The mother is dis-
health insurance is getting more expensive, my guid-
                                                                   abled with MS, but was insured through COBRA
ance and assistance leaves my clients much better
                                                                   for $600 per month. I put her on an Advantage
off than other people without help. They are happy
                                                                   plan and her daughter on individual coverage.
with their plans and well protected.
                                                                   When the mother realized the savings, she liter-
                          —Chilang W. Weiler (VA)
                                                                   ally cried tears of joy. I love my job. She just called
                                                                   today to say that the savings in premium will
I have a client who moved to Italy. Before she and                 allow her daughter to join a gymnastics team.
her family went, they terminated their policy. In the
course of the next 1 1/2 years, she received several               I am also helping a long-term client who had two
bills and statements that were either false or unpaid              grandchildren born in November with severe dis-
by the insurance company. Even though we were                      abilities. One of the babies died this week and the
not her “agent of record” at the time, we still helped             family is not able to make their way through the in-
our former client. There were two different orders                 surance options they have through their employer
to go to court for failure to pay her bills on time. We            or through the government.They are working with
were instrumental in unraveling the tangle of the red              Apple Health (our children’s program) and SS Dis-
tape, had doctors/hospitals re-file the claims, and                ability. These agencies aren’t coordinating with
the insurance companies to hand-deliver the claims                 one another so the grandmother called me for
                                                                   help. I was able to retain a HIPPA release and was

                                                           22
                                    I N D I V I D U A L       M A R K E T



   able to speak with both SSI and the Apple Health
   to sort everything out for this family. I won’t get
   paid a penny,but the personal satisfaction is grat-
   ifying and the family is thankful.

Another client aged 55 obtained what he thought
was Comprehensive Medical Coverage through
AARP. It wasn’t. He needs a tendon reattachment in
his thumb/hand and this coverage is not provided.
He bought this coverage over the internet and
trusted AARP. Had he worked with me way back
when, I could have told him this coverage was ex-
tremely limited. Now he is not insurable under our
state individual plan as he has a pending surgery for
which he will have to pay $37,000 out-of-pocket.

I also enrolled my mother on a Medicare Supplement
plan. She was thankful as she had been bombarded
with information that she just didn’t understand.

My point is that independent agents do good work
every day and should be part of the solution. We
provide a valuable service to the public. And, when
people take time to research their options, we can
find them affordable health care.
                            —Dana L. Brown (WA)




                                                         23
                                  Group Market

I am a part owner of an agency that sells both prop-           We personally enroll all new hires, explain the ben-
erty casualty and health insurance. I have been selling        efits and their options, assist in completing the pa-
group health insurance for about 10 years now and              perwork and continue to work with all of our client’s
spend a great deal of time working with the clients            employees throughout the year in claims assistance,
and the insurance companies. As agents, we are the             billing issues, qualified enrollment changes, etc. Ad-
spokesmen for the insured in many cases. At our                ditionally, we provide at no cost COBRA services to
agency, we have converted many of our client’s poli-           our COBRA eligible clients through a TPA we trust.
cies to qualified high deductible plans. We have edu-
cated our clients about the plan’s advantages and we           Many of our small business clients see us as part of
also educate their employees. We negotiate the re-             their team.
newal of their policies each year as well as counseling                                   —John Robinson (AZ)
them on what type of policy and which company they
should have their coverage with. We help them with
                                                               Michael has been the insurance broker for this company
claims and assist them by answering questions about
                                                               for almost 10 years. In that time, he has become an in-
individual situations. We also have to keep up with all
                                                               valuable resource in aiding the company in managing its
the changes that the companies make with regard to
                                                               insurance needs.
coverage and claims management.
                                                               Michael not only seeks out the best products to fit our
I cannot imagine who our clients would rely on to
                                                               needs annually, but we frequently call on him to assist
assist them if we were not here for them. In addition
                                                               me (the benefits administrator) with issues employees
to keeping up with the company changes, we have to
                                                               are having, or when I have questions about erroneous
keep up with the changes in legislation. A recent ex-
                                                               billing and coverage.
ample is the changes in the COBRA provisions. We
advised our clients of the changes and made re-
                                                               He always takes the extra step to follow up with us to
sources available to them to assist them in comply-
                                                               make sure any issue he helped us with was resolved to
ing. We offer seminars to the general public on topics
                                                               our satisfaction. His replies are always prompt, courte-
of interest to them. It may be that very large compa-
                                                               ous and effective.
nies with a large staff and experts regarding insur-
ance working for them don’t need an agent. I can
                                                               This company would be hard-pressed to muddle through
assure you that most small business owners need us
                                                               the insurance maze without his expertise.
and rely on us a great deal when it comes to insur-
                                                                                                          SUSAN G.
ance issues regardless of whether they are health in-
surance or property casualty insurance issues.
                                —Diane Taylor (AZ)             I am very involved with my employer groups and
                                                               my community of Sitka, AK in wellness initiatives.
                                                               Collectively, we have formed a model for commu-
My agency works primarily with small businesses
                                                               nity health that includes worksite wellness that is
(two-100 employees) and we provide the service of
                                                               being watched and duplicated by other communi-
a “mini-HR” department. Our clients cannot afford
                                                               ties in Alaska.
to hire a professional HR executive and rely on our
service to advise them in all aspects of their em-
                                                               As for making a difference with my clients, I believe
ployee benefits.
                                                               that is a broker’s job. I routinely am involved in help-
                                                               ing clients navigate the health care system, with mak-
                                                               ing contact for case management, care management,

                                                          24
                                           G R O U P          M A R K E T



assisting with claims, and often just being there for                verify the insurance coverage each step of the
individuals and family members that need moral                       way. Her attentiveness eased the parents’—
support. As a community service, I am often called                   and my— minds during a very difficult family
by non-clients and providers to assist individuals                   time.
with medical billing issues, finding providers, help
with Medicare issues and problem solving.                         Whenever we had a question about coverage, about pro-
                                                                  cedures, about unpaid bills, we simply gave Paula a call
In the complex regulation arenas of HIPAA, COBRA,                 and she worked directly with the employees to resolve
FSAs, HSAs and HRAs, I spend a great deal of time                 their problems.
working with clients and providing information so
they will understand the regulations, complex prod-               In 2001, I sold my business and moved to Lancaster and
ucts and compliance.                                              took a job as an administrator at a small private school
                                                                  with about 60 employees. After a year, I recommended to
My office phone, cell phone, fax and e-mail address               my boss that he interview Paula as a replacement broker.
are available to all clients and employees of my em-              Her record of service at my previous business had im-
ployer groups. Although I’m usually pretty busy, I                pressed me greatly. Paula comes to our location twice a
still encourage all of them to contact me with any                year, once to review plans and once to present to our
questions or problems they have.                                  staff. After she has met with staff and established our
                                                                  program for the year, she always makes herself available
I cannot imagine my clients and friends left to nav-              to talk with individuals about family concerns and spe-
igate the health insurance industry without a broker              cial circumstances. She is always just a phone call away
or agent to assist. A government agency is not going              for any employee with questions, problems or concerns.
to fill the need. For Alaskans, the challenges of
travel, available providers and distance to hospitals             Paula Wilson sends regular monthly, and sometimes
that can provide appropriate care cannot be under-                weekly, bulletins on changes in the insurance industry,
stood by anyone who has not been involved in these                laws and expectations and keeps our business office well
communities.                                                      informed on any issues that affect our coverage or the
                              —Paula M. Scott (AK)                administration of our plan.
                                                                                                             KAREN H.

I have worked with Paula Wilson for more than 18 years
and at two employers.                                             We rely on our broker representative to assist with en-
                                                                  rollments/changes/and terminations, to help with claims
At my previous business, as one of the owners, I needed           questions, to provide accurate and timely information
an insurance representative who would provide not only            regarding legislation such as COBRA or state insurance
good information for determining plans and employee               continuation as well as the new ARRA 2009 legislation.
benefits, but who would assist me in administering our                                                  MARILYNN A.
plan appropriately. As an owner of a company with
about 15 employees, I could not hire a plan administra-
tor and had little time or ability to deal with individual
employees and their concerns.

   When one of my staff had a toddler with a
   seizure condition that was beyond the ex-
   pertise of her pediatrician, Paula worked di-
   rectly with the parents to arrange for
   appointments with specialists at UCLA and to



                                                             25
                       B R O K E R S           M A K I N G              A    D I F F E R E N C E



We have used broker service for our health, dental and               Dear Colleen,
supplemental insurance for many years with the city of
Taylor. Jeff Kloc with the Benetex Group in Georgetown,              This is to thank you for the years of good service you
Texas has been instrumental in our renewal contracts                 have provided my clients. In 35 years as an administra-
with our insurance company. We could not do this with-               tor of businesses I have never found a broker that gives
out them. They go to battle for us in getting our rates              the consistently excellent service that Kosich & Calla-
down. The BeneTex Group also helps the employees with                han has provided. You are truly masters of good service.
not only claim issues, but all kinds of issues. They are a           Your staff is professional, friendly, patient, and always
tremendous help and support to my organization. They                 seem to be available by phone. They follow through
help me put on a health fair each year with my employ-               quickly with resolutions to inquiries. Moreover, you have
ees to implement health awareness. They also provide                 demonstrated excellent ability to solve underwriting
training for staff in regards to COBRA and HIPAA issues.             problems. There were times when you were able to get
                                              STARLA H.              coverage in desperate conditions. Your willingness
                                                                     to make house calls and presentations to employee or
                                                                     owner groups to explain insurance programs is a
Our health insurance broker is invaluable to me as a
                                                                     valuable service as well.
small business health insurance administrator. She has
saved our company time, money, and a lot of stress. She
                                                                     I cannot thank you enough for good service you have
helps me feel knowledgeable about difficult issues. She is
                                                                     given my clients. I continue to have total confidence in
always available to answer a quick question (without
                                                                     you firm’s advice.
going through the health provider’s customer care phone
                                                                                                                    JOHN C.
service that may take hours). She offers unique guidance
and knowledge of the health insurers and knows who we
need to talk to and what we should ask. She is the one               As the vice president of finance for a busy small busi-
who provides several competitive quotes during renewal               ness, I don’t have the time to monitor the constant
time, and has helped process difficult claims. I am                  changes in health insurance. Callahan Insurance knows
strongly opposed to any legislation that would eliminate             its business, which lets me focus on mine.
the services of insurance agents.                                                                                    ANN A.
                                               BECKY K.

                                                                     I was referred to Kosich & Callahan by a trusted asso-
I want to tell you how valuable my insurance agent is.               ciate and choose to continue to work with them because
My agent, Carol Anderson, gives me yearly advice on the              they have done nothing but patiently guide me through
benefits that my employees need and she does an out-                 the insurance process during our company’s seven year
standing job of finding the best plan with the best rate that        continuous growth. A friendly person always answers the
fits my office budget and that gives us the highest quality          phone and they return calls quickly. I also love that they
benefits. I can’t imagine the hours that she must put in to          keep me constantly notified of policy changes. I consider
find just the right plan for our office of eight people.             Dick and Colleen Callahan friends and will continue to
                                                                     be loyal to them.
I would not want the U.S. government telling me which                                                                KIM D.
plan to choose or how much the plan was going to cost
                                                                                                 —Colleen Callahan (CA)
without being able to make that decision myself.

Carol plays a huge role in my dental office to keep all of
us covered properly and I cannot imagine where we
would be without her.
                                            CONRAD C.




                                                                26
                                           G R O U P          M A R K E T



When we became the agents for Chris’ business we                  to the carrier. In addition, we follow up with the carri-
told her she was not hiring us to do quotes, she was              ers to make sure the employees have been added to the
paying for our advice and service. Over the next                  correct plans on the correct date they are eligible.
many months we worked with her employees and
managed the various service issues that came up.                  Most recently, I have been in contact with all of my
And then Chris became pregnant which was con-                     group clients to assist them with terminating employ-
sidered high-risk because she has lupus.                          ees during layoffs and letting them know about the
                                                                  new ARRA laws so that they can contact their COBRA
Any agent can get quotes and any insurance com-                   administrator or administer themselves. In addition, I
pany can promise to pay claims but the real test is               have been pointing those without an administrator to
when somebody really needs help. In Chris’ case it                the Department of Labor website to print the new no-
was matter of life and death.                                     tices to send to all employees who have been termi-
                                                                  nated since 9/1/08. In addition to this, I have assisted
Having lupus, Chris knew that at some point in her                many small groups in changing their plans off of their
pregnancy she was going to have to go off her med-                renewal anniversary in order to cut costs during these
ications. That day came and she became so sick they               difficult economic times.
had to take the baby almost two months premature.
I went to the hospital and held her hand while she                Each year, when the anniversary date occurs, I present
asked that I take care of her employees if this did               each of the companies that I work with a complete pro-
not work out. Chris died that night.                              posal outlining their current plans and comparing
                                                                  them to all of the other carriers’ plans to find the best
When Chris died it meant her coverage would cease                 fit for their business at that time. I analyze their situa-
at the end of that month for the baby. I called Blue              tion and make recommendations based upon the em-
Cross Blue Shield and told them I was going to use                ployers and employees criteria to find the best plans or
HIPAA and put the baby on their coverage. The peo-                combination of plans for their business.
ple at Blue Cross contacted the hospital to assure them
the baby would have continuous coverage and they                  If the employer decides to make a plan switch, we con-
facilitated the coverage change and claims payment.               duct employee meetings to explain the new benefit plans
                                                                  and enroll each employee on the new plans. We collect
When the renewal came up, Chris’s sister who now                  the employee and employer applications and DE-6 forms
ran the company insisted that the group be moved                  and other requirements from the employer and review
to Blue Cross no matter what the cost might be. We                them for accurateness. We contact the employer for any
made that move and they are still with Blue Cross.                additional items that were not submitted and send to the
                                                                  carrier. Then we follow up with the carrier to make sure
I tell you this story because I know what a differ-               everything is complete for issuance of the new contract.
ence a good agent can make in someone’s life.                     In addition, during these changes, there are often issues
                                —Bill Weaver (CA)                 with an employee or employees not receiving an ID card
                                                                  in time or needing to access the correct provider under
                                                                  the new plan. Perhaps there is an issue with the new car-
I help my clients daily by helping them figure out the
                                                                  rier not billing correctly and we assist with straightening
cost for new employees and their dependents. I send
                                                                  the bill out. Sometimes the old carrier does not cancel at
them worksheets with the rates for different plans and
                                                                  the correct date or close the claims correctly because the
the benefits, explain the benefits for the different plan
                                                                  wrong termination date has been input into the claim,
choices and compare the rates to the plans to make sure
                                                                  and we then work to fix these issues.
it meets each employee’s needs. I also assist with the en-
rollment of new employees by forwarding the applica-
                                                                  If any of the employees have issues with claims, I
tions and having the applications sent to my office where
                                                                  call the membership department for the carrier and
my staff reviews them for completeness and we forward

                                                             27
                     B R O K E R S          M A K I N G             A     D I F F E R E N C E



work with them to resolve any issues. If there is an             In closing, I have enjoyed my career in health in-
issue with billing, my staff and I contact the carrier           surance. I have been a Peace Corps volunteer and a
to correct the bill for the client’s benefit.                    community volunteer. There are many experiences
                                                                 for which I am grateful. It is helping people access
I have been in this business for 30 years and am a               and pay for health care that has given me the great-
professional. Service is the name of the game and the            est degree of satisfaction.
reason I retain 95% of my clients on an annual basis.                                     —Stephen W. Graeber (CA)
My clients are my business. They are the most im-
portant thing to me. I value each and every one from
                                                                 For over 25 years, English and Company has con-
the smallest to the largest and work each and every
                                                                 tinued to service, implement and communicate the
day to make sure they are satisfied with the plans,
                                                                 latest trends, designs and products to small busi-
rates, and services they receive from my agency.
                                                                 nesses throughout California. Our personal services
                           —Robert R. McIsaac (CA)
                                                                 along with our loyal clients have been our founda-
                                                                 tion. Over the years, our clients have seen the latest
Several times a month, I am contacted to resolve a               in providing benefits at the most valuable and af-
billing that seems inaccurate. Sometimes there is a              fordable manner possible due to English and Com-
coding error that can be changed easily. However, I              pany’s communication and servicing.
am currently working on a coding error that has yet
to be resolved in eight months.                                  At all times, the interests of the clients have come first.
                                                                 If I had not stayed in close contact through newslet-
I often receive calls from clients stating that they are         ters, phone calls and periodic visits, most of these
simply overwhelmed by the explanation of benefits                business clients may have sought other avenues with-
and the billings from providers. I will simply take the          out the personal services English and Company pro-
information, simplify it, and tell the client which bills        vides each and every day. Minimum annual renewal
to pay. The most complicated resolution involved mul-            reviews cover employee communications, allowing
tiple procedures at UCLA over a year. There were hun-            each employee personal time to make sure they un-
dreds of bills and EOB’s that I placed on an Excel               derstand the best methods for cost containment, uti-
worksheet and resolved to the client’s satisfaction.             lization and understanding how to get the best quality
                                                                 from their health care plans, ask questions and have
Sometimes we pursue resolutions for months that                  access to our personal toll free number.
should have been handled by the carrier in a day.                                           —Mary Anne English (CA)
One client placed her Primary Care Physician’s
(PCP) name and proper code on her application.
                                                                 We are a 501(c)(3) non-profit organization. Our insurance
The carrier made a mistake and assigned her to a
                                                                 broker, Misty Baker, makes a huge difference! She is always
medical group miles away from her home. She was
                                                                 available to me and to all of our staff to answer questions
on a Point-of-Service plan and was charged a co-pay
                                                                 about our policy and any other health insurance-related
each time she visited her PCP and did not realize
                                                                 questions we may have. She also makes sure we have the
she was being covered under the PPO portion of the
                                                                 most cost-effective, quality insurance policy out there and
plan. When she required testing, the deductible of
                                                                 she stays on top of the insurance issues that affect us all. As
her plan was charged and only a percentage of the
                                                                 a very busy non-profit manager, I depend on her and trust
bills were paid. This resulted in over $4,000 worth
                                                                 her. She not only saves me a lot of valuable time, but gives
of bills that should have been covered under the
                                                                 me the security of knowing that we are providing the best
HMO portion of the plan. I made two appeals (both
                                                                 possible health coverage to our staff.
rejected) explaining that the carrier had made a mis-
                                                                                            PAT GORDON BRODNAX
take when assigning the PCP. Finally, working
through an executive at the carrier, the client’s PCP
was changed and the client’s bills were reversed.

                                                            28
                                          G R O U P          M A R K E T



When I have my first appointment with a new client               The following are a few recent experiences that
who owns a business, I always say: “Let’s draw a line            made me feel good about what I do:
in the sand. I don’t want you in the insurance busi-
ness and you do not want me in yours. The only pa-               1. A client’s employee was going in for surgery
perwork I will ask of you is to pay your monthly                    and, as such, was fairly tense. He tried to do all
premium each month and I will take care of your new                 his homework ahead of time but when the hos-
employees being added on to the plan. When you                      pital told him he had a co-pay of $100 on his
have an employee who is leaving I will take care of the             HMO, he was confused and contacted his HR
necessary paperwork and make sure the Cal-COBRA                     department. They referred him to me, the bro-
or COBRA paperwork is complete. By doing all of this,               ker. I was able to speak with him directly and
you (the employer) do not have to worry about the                   provide the following resolution: I contacted the
insurance paperwork for your employees and you can                  insurance carrier and discovered they had his
continue to run your business without any hassles.”                 entire group coded incorrectly, they made the
                                                                    correction and refunded two other claimants
When I am enrolling a new employee to the plan, I                   who had paid the erroneous co-pay and the em-
will fully explain the benefits and value of the plan               ployee was able to go into his surgery with the
and explain how to get the ’best bang for his/her                   peace of mind that he was 100% covered, just
buck’. For example, when getting your preventive                    like he originally thought.
work done, do it at the beginning of the year so if
they find anything wrong, you will have the balance              2. A client with a new staff member had not prop-
of the year to meet your deductible and your coin-                  erly reconciled their carrier bills for several
surance. If you wait until the end of the year and                  months. Even though the carrier’s policy is to
they find something wrong and the treatment goes                    issue retroactive credits only two months back,
past December 31 into the next year, you will have                  we were able to advocate on the client’s behalf to
two deductibles and coinsurance. By doing it this                   obtain a $34,000 credit from the carrier.
way, you can potentially save yourself a lot of money.
                                                                 3. A client’s employee kept receiving a $550 bill
In some ways, I am the employer’s human resources                   from a lab that they didn’t feel they were re-
person off-site and payroll. There are many times I re-             sponsible for. In researching this bill with the
ceive calls from the employer asking me how to han-                 insurance carrier, we discovered that the lab
dle an employee situation and I do my best to give                  hadn’t properly billed the insurance carrier and
them good advice. I just don’t sell the plan; I am there            therefore the claim was denied. The lab tried to
to service it always. At the time of the yearly renewal,            get the funds from the employee, but according
I am there to ensure the benefits are being accessed                to their contract with the insurance company,
correctly and that the benefits are priced competitively.           they must write off the charges. We were able
If they are not it is time to shop around for benefits              to facilitate communication between all parties
that are more cost-effective. My first concern is always            to ensure the lab stopped billing the employee
the employer, not the insurance carrier.                            and did not send them to collections as had
                                                                    been threatened.
I have found, in 35 years, that most people look at
insurance as a foreign language and they want me                 4. A client’s employee complained to his HR de-
as their translator. They trust me and the services                 partment that his wife’s prescription drug claims
that I represent. The agent does matter!                            were being declined. My colleague researched
                                —Jerry Abels (CA)                   the issue and found the problem. She explained
                                                                    the dual coverage details to the employee,
                                                                    helped him analyze whether they should main-
                                                                    tain dual coverage, and developed a system


                                                            29
                      B R O K E R S          M A K I N G              A    D I F F E R E N C E



     where we intercept the prescription drug claims               I appreciate that the purpose of any type of reform is to
     to have his insurance carrier manually adjust                 improve what is assumed to be a flawed issue. But I do
     them and reimburse their monthly out-of-                      not believe that government was created to put unneces-
     pocket expenditures.                                          sary burden on companies or to offer a constant handout
                                                                   to those not willing to do anything for it. Our broker for
These are just a few day-to-day examples of ways                   insurance offers our business an asset that, quite hon-
brokers and their staff can and do help folks deal                 estly, I don’t feel the government is able to handle. I
with very real issues in their lives. Our detailed and             wouldn’t pay for sub-standard service and I’m really just
professional knowledge and understanding of the                    not interested in the offer that is currently being pre-
industry allows us to help people save time, energy                sented as an alternative.
and money by advocating on their behalf through-                                                 RAMONA TIRE, INC.
out the health care system.
                             —Cerrina Martin (CA)
                                                                   I make a difference in the lives of my clients every
                                                                   day. I have been an insurance agent since I was 22
Please accept this letter as my way of stating the im-             years old, and I am now 48. My primary focus used
portance of our broker for the use of our company’s                to be property and casualty products, but over the
health insurance. Each year as we begin to come close              last 10 years, I have concentrated on health insur-
to our open enrollment period, I can always count on               ance. I love helping people and that is why I love
our broker, Paula Wilson, to come to the table with sev-           my job. In California, there is guaranteed health cov-
eral options, companies and prices for us to look at. The          erage for employers with at least two full-time em-
thought of not having this type of personal service or             ployees, but most businesses are not aware that this
even worse, the thought of having to find the time to              guaranteed coverage exists. I am a strong advocate
shop for these services myself, along with having to have          and assist people with setting up small group plans.
the knowledge that goes along with it, is nothing short of         So many satisfied customers have told me that they
terrifying. Paula has always been available to all of my           never knew of the guaranteed-issue law in California
employees if they were having a problem with their cov-            and are so grateful to have an experienced agent to
erage and she has always been happy and quick to re-               work with.
spond. She is also a huge help to me in dealing with
sometimes-uncooperative health care providers. You just            In addition, with so many flexible options that the
can’t replace human relationships with a voice on the              carriers present to small groups, the employees and
telephone. It is a full time job handling the daily payroll        their dependents can choose the plan that is right
and human resource duties for my company and I don’t               for them. I think all Americans want choice when it
believe that putting extra undue and unnecessary pres-             comes to health care. And in California, that is what
sure on a single individual is good for anyone, especially         an agent can offer…choice! I have had so many peo-
since we are talking about health care issues.                     ple that have researched insurance plans on the In-
                                                                   ternet only to come in my office and say that they
I believe that it is in our country’s best interest to have        need an agent to help determine the best plan for
businesses compete for the business of their clients be-           their needs. That is what an agent does…we help
cause it brings about better customer service, honesty             people and guide them through the process. Agents
and pricing. I also feel that the government itself seems          and brokers are a vital tool in the health care system
to have quite enough on its plate to be anywhere close to          and I love my job of helping people every day!
handling that job as well as agents do. Brokers are pro-                                               —Jeff Kane (CA)
viding a service for those who choose to use and pay for
that service and for those that choose not to use them
there are other options available.




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                                           G R O U P           M A R K E T



Please be advised by this letter that we at KAYEM Pipe             daily on proper procedure. We are very aware of our
& Steel, Inc. are very pleased with the very necessary             clients’ needs and always have a real person answer
and important services provided by Mary Lou Hudman                 our incoming calls. Our staff strives to satisfy the
with A Benefit Source. We would be lost without Ms.                needs of that client on that phone call. We also have
Hudman’s knowledge and expertise in helping our com-               one of our staff members whose job is to help our in-
pany not only make a prudent decision regarding the in-            dividual members with claim and administrative
surance provider and premiums, but even more                       needs that our insurance companies cannot respond
importantly Ms. Hudman has been a great source for ex-             to in a timely manner. This person and the rest of our
plaining, educating and assisting myself and all of my             staff have helped our agency have a 97%+ consistency
employees with understanding our health coverage pol-              rating over the years. Our primary focus is to provide
icy and its limitations. Our broker, Ms. Hudman, helps             the best service of any agency in western Colorado.
every employee individually with personalized assistance                                           —Bill Killgore (CO)
in expediting claims, large or small. Honestly, there is no
way that I or any of my employees could deal with the
                                                                   I would like to brief you on some of the things that Angie
insurance company directly for the types of services—
                                                                   and Lori do to service our account here at Greenville Me-
they are simply not available.
                                                                   chanical, LLC.
   Eliminating the role of our insurance
                                                                   Greenville Mechanical has been in business for 35 years
   agent/broker would be devastating to our
                                                                   and when I became employed here in 1987, we had of-
   ability to make prudent decisions when it
                                                                   fered health insurance. Due to the rising cost of benefits
   comes to comparing and purchasing health
                                                                   each year, the president at that time decided to cancel all
   insurance best suited for our company and its
                                                                   health care coverage and give the employee a monthly
   employees, to help with adding new hires, to
                                                                   stipend to help the employee obtain health coverage on
   make certain we are in compliance with
                                                                   their own.
   COBRA, to reconcile claims benefits and to
   make certain that billing statements are cor-
                                                                   Upon his death in 2005, the newly elected president then
   rect. Our insurance broker is a vital resource
                                                                   addressed bringing back health insurance coverage to the
   for information, claims expediting, and more
                                                                   company. Creative Insurance Company came recom-
   importantly educating each individual em-
                                                                   mended to me from several outside sources. Everything
   ployee about how the health insurance pro-
                                                                   I was told about these two ladies has turned out to be ab-
   gram we have purchased applies to their
                                                                   solutely the truth about their honor, honesty and ex-
   personal lives.
                                                                   traordinary level of service they give to their clients.
I therefore ask that you please allow the health insur-
                                                                   I have been working directly with Angie & Lori now for
ance agent/broker to continue to provide this vitally im-
                                                                   four years. Not only do these two ladies bring forth the
portant and necessary service required by individuals,
                                                                   best carriers for our situation, but they also provide each
families and corporations.
                                                                   insured employee with personal service. They research
                               DOUGLAS J. KAYE M
                                                                   each insured employee’s coverage and try to find them
                                                                   the best fit with cost, helping approach doctors that are
We have an agency of 10 folks here in Western Col-                 not in network for coverage consideration, helping em-
orado. The new COBRA regulations have been very                    ployees that are retiring understand their options with
confusing to our clients and for the past month, we                Medicare, resolving billing discrepancies, listening to us
have been holding employer meetings to assist our                  in a time of crisis, giving insurance meetings at 7:00 am
clients in managing the new regulations. We have                   or 7:30 am (whatever time we dictate they are there)
been providing them with copies of the regulations,                and rewarding us with Christmas breakfast every year
election forms and the new IRS 941 form. Our meet-                 (even for the employees who elect not to be insured).
ings have been detail-specific and we are fielding calls

                                                              31
                       B R O K E R S           M A K I N G              A    D I F F E R E N C E



 These have been just a few things that come to mind off the         Our agent’s recommendations are always based on what
top of my head…Angie and Lori go over the top to make                is best long term for MAC Papers. Plan Analysts has al-
sure this account is serviced, serviced and serviced!!!              ways been our advocate. . . . [they are] a successful ad-
                                                                     vocate between their clients and the insurance carriers.
Greenville Mechanical is fortunate to have them in our                                               DARNELL BABBITT
fighting ring.
                                   CINDY APPLETON
                                                                     …Plan Analysts was able to enhance our benefit pack-
                                                                     age for relatively no increase to Masthead Industries.
With your knowledge of the benefits and insurance in-                                                   PAT TERRANOVA
dustry, you have helped supply quality benefits at com-
petitive prices. What I appreciate most is the many,
                                                                     …Through the years, I have remained confident in your
many hours of labor you saved me and the confidence
                                                                     ability to perform the necessary due diligence and to rep-
you gave me that we had the right policies to offer.
                                                                     resent the best interests of my company when evaluating
                                          SAM TAYLOR
                                                                     and negotiating with various carriers. It is very reassur-
                                                                     ing to me to know that this crucial aspect of my business
We are pleased with our current benefit programs and                 is in the hands of someone I can trust.
believe that we have a strong combination of quality and                                  WILLIAM T. BUCKINGHAM
price. You are always willing to go the extra mile! We
appreciate your insight into our needs and your ability to
                                                                     …Most companies don’t give us the kind of superior
bring appropriate solutions to us.
                                                                     service yours does; you have always provided us with su-
                                     DAVID GRAHAM
                                                                     perior benefits. I know insurance is a very competitive
                                                                     business but few offer the quality and professionalism of
Immediately you stepped up, taking the action to estab-              Plan Analysts.
lish an accurate database of our group’s membership.                                                 THOMAS A. BRYAN
You and your staff provided excellent service to our staff
                                                                                                          —Larry Lee (FL)
and employees during this transition.
                             JEFFREY H. ANTHONY
                                                                     I fully understand the need for health reform and af-
                                                                     fordable medical insurance, but I am not sure that na-
Larry is not a salesman, he is a partnership builder. He
                                                                     tional health care would be the answer.
is an agent, in the truest sense of the word. Larry repre-
sents his clients and isn’t shy about asking for those things
                                                                     We have used the services of insurance broker, Pritchard
that will help them succeed.
                                                                     & Jerden of Atlanta, GA since 1999. Prior to 1999, we
                                        PAULA RUTILI
                                                                     used the services of CUNA Mutual Insurance and
                                                                     worked with Mr. Charles Caswell at CUNA and then
With your aid, we were able to reduce our potential lia-             with him and his staff when he became associated with
bility by over 50%.                                                  Pritchard & Jerden.
                           MICHAEL A. SANDIFER
                                                                     I have worked with Jill Bushnell for several years and
                                                                     have found she has always been attentive to the needs of
Superior service, knowledge of the industry, and skill is
                                                                     our organization, not only in negotiating the best rates
what makes you valuable to our company… It is also a
                                                                     for us, but whenever we needed assistance or follow up
pleasure to work with your staff. They have always been
                                                                     with insurance carrier issues. I feel there is a definite
helpful, professional and courteous.
                                                                     need for the insurance broker industry above and be-
                                     ANN LOCKHART
                                                                     yond any initial sale. It has certainly been true in our
                                                                     case and makes our lives easier knowing we have

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                                             G R O U P           M A R K E T



someone to “go to bat” for us with the insurance carriers            to navigate the insurance marketplace are all having
if and when necessary. Over my years, I have seen the in-            a hard time trying to figure out who will take them,
tervention of our brokers on our behalf to help with issues          and trying to see what plans are going to serve their
that were not being resolved with the carriers.                      needs the best. These are important decisions for
                                                                     anybody. Their HR department always handled all
There have to be many other alternatives to consider on              of this and they just really don’t know the system.
health reform and I hope that our legislators see fit to pur-        These folks all need help with these decisions.
sue all the options before considering national healthcare.
                                      JEAN O’MALLEY                  In my office, we try to take on the role of an advisor,
                                                                     not just an insurance pusher. If that is all we were,
                   —submitted by Jill Bushnell (GA)
                                                                     it would still be difficult for a business owner to take
                                                                     on this responsibility, but we do so much more than
I believe that it is important to have an agent in the               that. We offer many services so employees don’t
corner of every business, especially the small busi-                 spend all their time on the phone trying to fix their
nesses. These hard-working business owners are al-                   bills—that could be enough lost time for an em-
ready trying to wear a lot of hats—they are the HR                   ployer to drop the coverage. We also work on billing
person who hires their staff, the CFO who handles                    issues and basic service issues. I think we have
all the financial concerns, the customer service de-                 amazing insurance companies that really strive for
partment, the ad agency and often even the janitor.                  excellent service, but there are always things that
They really can’t take on the job of insurance agent                 come up. Worse than that are all the companies that
as well. It takes me a long time to gather the infor-                pop up promising to be “like insurance companies”,
mation to show a group the best plans that are avail-                or that work through associations and can handle the
able for them. I am already hooked into the systems                  insurance needs of all people who pay a few bucks
and speak the language but it still takes me a good                  extra each month just to join the associations. And
deal of time. Imagine these business owners who are                  there are the ones who just collect the money and
already overworked and tired, but want to do a good                  aren’t really associated with any insurance company.
job for their employees and take care of them. Now                   How quickly these folks will pop up to take the
they may have to try to figure out the best insurance                money of hard working people who don’t know the
plans and companies, and then try to figure out how                  system. I realize that this goes on even now, but with
to get on a “pre tax” plan, and then try to explain to               the Internet and NAHU and other ways to legitimize
their employees what their benefits consist of. When                 ourselves, we are able to slow down the losses from
all that is done and the employee has a hospital bill                these dishonest people. Without agents, all it will take
that doesn’t get paid, or ID cards that didn’t get de-               is a person who drops by, says he is with an insur-
livered, or there is a bill that doesn’t look right, are             ance company and promises to cover them. Now this
they are supposed to be a full-fledged insurance                     owner is out some money and perhaps on the line for
agent, too? They need to have somewhere to turn for                  medical bills for an employee. Why would anyone
the answers. Think of all the time we spend in classes               want to put business owners through this?
and informational courses to learn about the greatest
new plans and the correct procedures. Small business                 We contact our clients all year long with updates on
owners don’t have that much time on their hands.                     what is new in the industry and what laws are chang-
                                                                     ing. I cringe to think of what our clients would have
Furthermore, think of how confusing the Medicare                     done if we hadn’t kept them abreast of the HIPAA
system is to our senior citizens, and now you want                   laws and the COBRA changes that have come up. I
them to try to decide which Advantage or Supple-                     have run classes through our Chamber of Commerce
ment is the best for them (sorted by county, com-                    and published articles as well as working directly with
pany and then by plan design??!!??) The individuals                  my own clients to make sure our community is keep-
who have recently been unemployed and are trying                     ing up with the rapid changes that are occurring.


                                                                33
                     B R O K E R S         M A K I N G             A    D I F F E R E N C E



These are very important laws and business owners               Dear Dan:
need to be following them carefully. I have made so
many businesses aware of their need for workers                 As you know, my business, Hesse Financial Advisors LLC,
compensation (an insurance item that I don’t carry),            completed a change in ownership a few months ago. As a
and liability insurance. I have helped many of them             result, I became a managing partner of the firm, and was
understand HR laws, such as Georgia Continuation                charged with the responsibility to replace numerous busi-
of Coverage. One client mentioned to me that she had            ness functions with local providers to maintain a seamless
purchased applications from Office Depot, and was               experience for our clients. All of these changes occurred at
amazed that they didn’t ask the questions she believed          the same time, and all required a high level of urgency and
were important. She explained how she ’whited- out’             accuracy. Implementing a new health plan was one of our
the questions she didn’t care about and typed in “age,”         internal functions on the list.
family status,” and other details she wanted to know
about. She was neither stupid nor nosey, she just had-          We had two goals, 1) to provide our staff with a similar
n’t hired anyone for many years and didn’t realize the          cost structure to what we had previously, even though we
laws had changed. Agents are in the business’ offices           didn’t think this was possible since the previous owner
all the time; we provide ideas and information that             was a Fortune 200 business, and 2) to match or improve
they can use. I have helped many businesses with net-           upon the benefits we offered our staff. These were sub-
working, advertising and even hiring. I work very               stantial objectives for any sized business, let alone a
hard, and between my information and the letters that           small firm like ours.
I have received from my clients, I think it is pretty
clear that they consider my proficiency very impor-             I can’t thank you enough for the many meetings at my of-
tant to their insurance package. I intentionally take           fice and for your analysis of our situation. You ultimately
them out of the insurance business. That is not what            delivered us a package that exceeded our expectations
they know about. That is my job and my area of ex-              and achieved both of our stated goals. I so appreciate
pertise; with me around they don’t have to know                 your patience and your skillful knowledge as you listened
about it. I keep them informed, I negotiate their rates,        to our various requirements and maneuvered us to the
I advise them of which companies are A-rated (AM                finish line of this obstacle course. We have since imple-
Best). Most people don’t even know what that means              mented your recommendations and we are completely
until I tell them. They don’t need to be insurance ex-          satisfied.
perts; they need to take care of their business.
                                                                Thank you for going above and beyond to help us ad-
I’m afraid that if we make it harder on people to               dress our health plan needs. I encourage anyone with a
have insurance, more businesses will decide not to              small business to discuss their situation with you, so that
offer benefits and that will be a fiasco. Many indi-            they can also experience the Dan Boaz “touch” and
viduals, when faced with a job they know nothing                achieve their specific objectives.
about, refuse to take action. This would be a big                                       STEPHEN A. SIDERS, CFP
problem for our unemployed individuals as well as
                                                                                                      —Dan Boaz (GA)
our seniors. I realize that changes need to be made,
but don’t try to make the business owners take on
more important roles than what they already do, and             This is to tell our story on behalf of our Group
then hold them to strict laws that will punish them             Health plan agent, Misty Baker, of Lonestar Benefit
if they don’t get it right. It is the business and the          Solutions.
employee that will pay this awful price.
                                —Linda Mackey (GA)              Xidex Corporation is an emerging Austin, Texas-based
                                                                nanotechnology company with three full-time employees
                                                                and three part-timers. The products we sell are used by
                                                                the semiconductor industry and in industrial and research


                                                           34
                                              G R O U P            M A R K E T



laboratories worldwide. Misty has been our group health                any problems with the carrier, she will pick up the phone
plan agent since we formed the company in 1997.                        and call them herself…until I am completely satisfied—
                                                                       which, by the way, can be a tough job in and of itself.
A company this size cannot commit resources to in-house
human resources staff, whose job it would be to answer                 Joan Sondag has worked with me on workers compen-
questions about operation of the health plan, serve up                 sation and general liability issues. Joan has always as-
alternatives when the plan needs to be re-bid, and deal                sisted me with rate breakdowns for each building that
with other questions as they arise which are critically im-            we are insuring. If I need a certificate of liability for one
portant to our individual employees. We have relied on                 of our customers, it is taken care of immediately.
Misty Baker to provide these services for our company.
She has always done so in a very knowledgeable, pro-                   I really just can’t say enough about all that Pritchard &
fessional, gracious and timely manner. Without this kind               Jerden does for our company. Everyone I have worked
of support from a knowledgeable, caring agent like Misty,              with goes above and beyond the call of duty. I would say
it would be virtually impossible to find the time and ex-              that I speak with someone from Pritchard & Jerdan on
pertise to manage our group plan.                                      a weekly basis.

I am pleased to provide this statement on behalf of Xidex              I can’t imagine not having them around.....
Corporation and hope it has a positive impact on the
health insurance reform process.                                                          —submitted by Jill Bushnell (GA)
                                       PAUL MCCLURE

                                                                       In specializing to provide insurance service to public
I would like to say that our brokers do a tremendous                   entities in Idaho, I work with local board members,
amount of work for us after the sale is made. They are                 mayors, clerks, city councilmen and commissioners.
always there to help us with problems and issues that we               Most, if not all of them, depend on me for sorting all
don’t understand. Recently, they have been a tremendous                the benefit options and rates so they can maintain a
help to us with the COBRA stimulus deal. We would def-                 balanced budget. There is so much competition and so
initely be hurting if we didn’t have them to call on.                  many choices that a broker can save thousands of dol-
                                         LUANN SMITH                   lars and negotiate better benefits and credit by know-
                                                                       ing the policy contracts and working for the client.
Wow! Where do I begin? Pritchard & Jerden has worked
                                                                       Last year, we were able to save a local county over
with W.E. Marshall Company for 15+ years. Each year, I
                                                                       $270,000 in one year moving to a competitive bid-
have at least five different agents wanting to give us a quote.
                                                                       ding situation and negotiating a better deal with
And, each year, I tell them I am more than happy to hear
                                                                       their current carrier. Without a broker, the company
what they have to offer, but in all honestly they would not
                                                                       would just give a rate and there is no negotiating or
be able to come close to what we receive from Pritchard &
                                                                       any reason to be priced competitively.
Jerden in terms of value and customer service. Pritchard
& Jerden has always given us more than 150% in customer
                                                                       We need to keep health insurance in the free market
service. And, at no time, have we ever felt that we were
                                                                       to continue providing the customer and the con-
being billed unjustly.
                                                                       sumer with options. It is the only way to lower rates
                                                                       in addition to promoting wellness, fitness and
For at least seven years, I have worked with Jill Bushnell
                                                                       healthy lifestyles.
very closely. Each year at renewal, Jill works very hard
at marketing health insurance carriers for our company.
                                                                       Thank you for listening and your time with this im-
Once a carrier has been determined, Jill works with me
                                                                       portant issue.
on the rate calculations for each employee. If I ever have
                                                                                                  —Lori L. Bergsma (ID)



                                                                  35
                     B R O K E R S          M A K I N G             A    D I F F E R E N C E



In January, one of my small business clients was try-             has imposed (HIPAA, COBRA, Medicare Part D,
ing to hire a key person away from a competitor (the              Women’s Healthcare Act, etc.) and we were able to
competitor actually offered twice his old salary to               get them up to speed on how to manage and process
keep him). This key person had a special needs child              the additional obligations now in-force.
and they had spent over $19,000 out of his own
pocket last year on charges that their prior carrier              As insurance professionals, it is our duty not to sell
didn’t cover. I was brought in to help with wooing                insurance, but problem-solve our area of the insur-
him. I compared his current plan to my client’s plan              ance puzzle. A snapshot of the major players in the
with regards to the physical therapy needed for his               insurance puzzle include the government, hospitals,
son. Next, I called the son’s physical therapists to see          physicians, pharmaceutical companies, retail phar-
what networks they were in. When we found out                     macy companies, insurance carriers, research uni-
that one wasn’t in the network, I was able to dis-                versities and companies, our own populations
cover a cash discount rate that was equal to the net-             ever-changing health care habits, etc. It is dynamic
work negotiated rate. I took the expected costs for               and complicated, to say the least, and our role is to
the child and put them on a spreadsheet for my                    educate the insured population on areas that they
client. They were able to take this spreadsheet and               might have an impact or be impacted. That means:
come up with an offer that the key person accepted.
                                                                  Government Legislation - Keeping our clients com-
During this time, I also had three-way discussions                pliant and educated on what they can do to fight for
with the key person and hiring manager from my                    or against legislation that affects them and their em-
client’s company to describe the insurance, answer                ployees. We also have the task of keeping our clients
all his questions, and reassure him of its quality.               compliant with laws and regulations.
                              —Robert Slayton (IL)
                                                                  Hospital & Physicians - Keep our clients and their
                                                                  staff aware that they should choose high quality care,
Below are some examples of how agents/advisors do
                                                                  not just less expensive care as measured by inde-
more for their clients than just get involved in the sale.
                                                                  pendent firms like Healthgrades. As a broker we
                                                                  have the opportunity to speak directly with the end-
A small group had a member that needed cancer
                                                                  users of healthcare and educate them on the “sys-
treatment to begin immediately. However, the car-
                                                                  tem” and the options available to navigate it.
rier required a 60 day predetermination for neces-
sary treatment. We got involved with the nervous
                                                                  Pharmacy - All drugs are not created equal, but
and upset client, carrier, and physician and imme-
                                                                  sometimes they are and the cost to the company and
diate treatment was granted. The client was put at
                                                                  member can be very large. Are Lipitor, Crestor and
ease as much as possible and allowed to concentrate
                                                                  Zocor (all brand name Rx) the same cost? Do con-
on fighting the disease rather than fighting with the
                                                                  sumers have options? Is there a benefit expert avail-
insurance carrier for necessary coverage.
                                                                  able to employees to educate them to work with
                                                                  their physician?
A small company was facing a large increase in pre-
miums because of significant health issues. No al-
                                                                  Retail Pharmacy - Is the same drug priced differently
ternative carrier was less expensive and we worked
                                                                  at Walgreen’s vs. Costco vs. CVS? Who is educating
with the company and its employees on educating
                                                                  the employees and staff? We are.
them about lower cost pharmacy and emergency
care practices. We changed the plan design to lower
                                                                  Insurance Companies - A well-run health insurance
premiums and provide low upfront costs, but sig-
                                                                  company wants to make three cents of every one
nificantly less total exposure should large health care
                                                                  dollar in profits. Is that the big bad insurance
issues arise. This client was also non-compliant on
                                                                  company that everyone wants you to be afraid of?
many of the legislative obligations the government

                                                             36
                                        G R O U P         M A R K E T



The problem is that each of the players in the equa-          ployee meetings) and providing adjudication serv-
tion has to make profits or margins necessary to exist        ices when claims are not being processed to the sat-
and I would find that government agencies involved            isfaction of the client.
in health care are not as efficient as the insurance
carriers. Insurance companies usually aren’t subject          Not only are clients kept abreast of changes in legisla-
to the emotional side of health care as they are using        tion that could affect how they administer their em-
clinical data to pay claims and sometimes the mem-            ployee benefits packages but we provide one-on-one
ber gets hurt. Our job is to take away that pain and          consultations and quarterly site visits. A recent case in
work with the carrier in resolving the problem and            point occurred recently. The president of a firm turned
making the member affected a person to the carrier            65, and was immediately informed of coordination of
versus just another claim code.                               benefits with Medicare. As a result, he signed up for
                                                              both Part A & B and began paying his major medical
Unfortunately, the government has good intentions             premiums at a reduced rate. Three months into the
but rarely has the right answers to health care prob-         process, Medicare raised his premiums significantly. He
lems and generally makes health care more expen-              advised me of the situation and asked if I could explain
sive to the many so the few have their say. Our job           what was happening. Since he was in the small group
as brokers is to listen and provide answers, educa-           market, Medicare should be primary and I could not
tion and solutions to help businesses navigate with           contemplate why the premiums were adjusted. I ob-
as much success as possible through the maze of               tained an authorization from him and personally drove
health care. Our cost is marginal in the equation of          to the Social Security Administration Office. After over
health care and the forces that truly drive this are          an hour of waiting, I was able to speak with a repre-
the government inefficiencies (Medicare/Medicaid),            sentative, but after a short conversation, I was informed
hospital and physician liability insurance costs and          the authorization he had signed, which had been sup-
the uninsured. The fact is, lawyers probably make             plied by SSA, was for medical records release and
as much profit in health care as many of the legiti-          would not be acceptable. I am now in the process of
mate players that are truly behind treating and ed-           obtaining a different authorization and will return for
ucating our nation’s health care consumers. Our               a full explanation. This is only one example of provid-
agency spends more than 80 hours per year on ed-              ing value added for my clients.
ucating staff as well as assisting the insurance com-
mittee in making long-term decisions that will                I have spent literally countless hours with indi-
impact their health plans.                                    viduals reviewing claims and seeking resolutions
                                  —David Levitz (IL)          or at least understandable explanations. Working
                                                              in the public sector requires even more attention.
                                                              I have spent many an afternoon and evening with
As a broker for 20+ years, it has been my contin-
                                                              union representatives developing cost saving
ued pleasure to provide value-added services for my
                                                              strategies for both their members and the tax
clients. Not only do I provide an aggressive mar-
                                                              paying public.
keting posture when supplying proposals but every
effort is made to convey the negatives and positives
                                                              To be sure, when renewal time arrives we will au-
of the carriers being represented. It is a goal to ex-
                                                              tomatically request substantiation for any increases
plain the differences to potential clients and make
                                                              to our clients. If the response is not in line with cur-
sure they have enough information to arrive at an
                                                              rent trends every effort is made to negotiate with
informed decision. Once a decision is made and the
                                                              the carriers and reduce the premiums. If unsuc-
program is in place it is our perceived responsibil-
                                                              cessful, we have surveyed like groups in the geo-
ity to ensure all employees and/or individuals are
                                                              graphic region and industry and made comparisons
taking full advantage of the programs offered. This
                                                              to support our arguments for reductions or rein-
is accomplished through ongoing education (em-
                                                              force the carrier’s position before presenting the


                                                         37
                      B R O K E R S          M A K I N G             A    D I F F E R E N C E



renewals. Good brokers provide these kinds of serv-                would not bill the medical insurance company be-
ices regularly. If legislators feel all we do is sell a            cause they did not want to accept the negotiated fee
product and collect commissions they are ab-                       schedule. Rather, they billed the auto insurance com-
solutely, categorically incorrect. They should exam-               pany (which paid the $5000 maximum under the pol-
ine the compensation schedules and realize we                      icy but did not have a negotiated fee schedule with the
aren’t being compensated at a 40%-50% rate that at                 providers) and balance billed the patient. The sur-
least one senator’s aides believe.                                 geons refused to bill the medical insurance company
                                    —Bill Lavine (IL)              for months and months, during which time, they ha-
                                                                   rassed the member to pay the $40,000 balance—start-
                                                                   ing out with multiple phone calls and eventually
I have been a small business owner for over nine years
                                                                   threats of collection.
and currently employ 15 people in the Dallas area. In
that time, I have observed what seems to be an apparent
                                                                   We talked to the medical insurance company to de-
effort by lawmakers to place an additional burden on
                                                                   termine the key item to submit for reimbursement
small business owners, though we are the ones they claim
                                                                   in-network and then coached the member on what
are the ‘backbone of our economy.’ Unlike most of the
                                                                   to ask for. Eventually, he was able to get by the
large businesses I read about lately, we have proven to
                                                                   billing office and talk to an administrative assistant
our employees in these challenging economic times that
                                                                   in the surgeon’s office. The HCFA5500 form was
they are valued and that they will have a job tomorrow.
                                                                   submitted, showing the in-network tax ID for the
If I see value in something that helps me provide the most
                                                                   doctors, and the bill was paid in full (at the correct
cost-effective benefits to my employees, why would you
                                                                   reimbursement level).
take that away? Without question, I have seen the value
of my agent/broker not only in helping me evaluate and
                                                                   Value to our customer: $40,000, plus avoiding hir-
understand the many employee benefit options, but also
                                                                   ing an attorney.
in assisting with claims and correcting billing statements.
If lawmakers want to do something to strengthen what
                                                                   Value to us: Priceless—there is nothing as satisfying
they claim to consider so important to our economy, why
                                                                   as helping a customer, especially one who had fol-
not start by listening to the small business owners instead
                                                                   lowed all the rules and was a victim of a “bad player.”
of placing yet another hurdle on the track?
                                                                                                      —Greg Smith (IL)
                                        JOHN W. SPIARS

                                                                   My clients don’t know the complicated rules sur-
This is an example of persistence, knowing what
                                                                   rounding insurance. They have trouble dealing with
should happen, and then making sure it does hap-
                                                                   insurance companies for claims, for benefits and for
pen—all to help our customer understand their ben-
                                                                   premiums. I have a staff of three to handle these
efit program, how to use it, and intervene when
                                                                   problems for our clients, and I am constantly ex-
things don’t work as they should.
                                                                   plaining benefits and health plan usage.
Another NAHU member and I worked together to
                                                                   I have nearly 100% agreement among my 100 busi-
solve a problem created by a dishonest provider’s
                                                                   ness group health plans that the government should
billing office.
                                                                   not be involved in health care. We look at Medicaid,
                                                                   Medicare, the post office and local government to
Our customer, an employee of a very small employer,
                                                                   support the argument that private companies do a
needed spinal surgery as a result of an auto accident.
                                                                   better job. Most of my clients feel that the increased
We advised him on how to find the best providers for
                                                                   cost in private health care is due to government in-
the surgery and how to stay in-network. The surgery
                                                                   tervention already. Cost shifting from Medicare and
was successful, and all providers were paid according
                                                                   Medicaid, as well as policy amendments, have added
to the contract except for the surgeons. The surgeons
                                                                   significant additional costs to our premiums. Offer

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                                             G R O U P           M A R K E T



tax incentives, increase transparency, but do not allow              provides a unique set of business challenges while
the government to run health care. The Constitution al-              trying to provide each employee and their family
lows the government to do a lot of things. Protecting                with the necessary protection they deserve for being
our country is one of them. Health care is not.                      the number one asset the company possesses. My
                                  —Mark Brown (IL)                   employer clients all rely heavily upon me to help
                                                                     navigate these challenges each and every day.
                                                                                                        —Trip Dill (KY)
I am a benefits coordinator for our company’s human re-
sources department. I do not feel that eliminating the bro-
kers from the insurance market will streamline the system               Our insurance agent is a vital part of our over-
at all. It will all but remove personal service from the in-            all organization. As a small business, even
dustry and force individuals to attempt to contact a human              though we have an HR department, we occa-
being at a huge corporation through a mass of automated                 sionally have problems with our coverage.
phone menus. There have been many times that myself and                 Things like getting new employees on the in-
co-workers have turned to our broker for assistance on                  surance policy and prescription card rejec-
claim information that most of us simply do not under-                  tions are things that our agent speeds along
stand. By turning to someone that we trust and who knows                more quickly than we can. A most recent ex-
the system and has contacts in the insurance company, we                ample is the merger that we have just com-
have been able to make sure claims are paid according to                pleted. Our agent helped us negotiate much
the policy and have actually obtained refunds from physi-               better health care rates, she helped smooth
cians that have overcharged us. It is also very helpful when            the transition of merging two companies and
competitively looking at the different insurance companies              their health care plans, and she was available
to have someone that is familiar with the companies and                 to us immediately and took care of the prob-
their trends and service history. Health insurance is a very            lems that we could not resolve. I think this is
costly part of our budget and we must diligently look for the           because our particular agent writes so many
very best price.                                                        policies that the insurance companies pay
                                                                        more attention to her than to individual policy
As an individual, our broker has helped me to find an                   holders. I shudder at the thought of the red
independent policy for my husband who is self-employed.                 tape and drag on the system if the govern-
It was extremely helpful to have her in our corner and be               ment takes over health care. Leave it to the
able to contact her to ask questions to make sure we were               professionals in the insurance industry!
getting the very best policy for our hard-earned money                                     BRYAN N. AND CAROL A.
as this is a large part of our personal budget as well.
                                                                     I have been in the insurance business since 1992,
I agree that there are many problems with our current
                                                                     working in areas from property and casualty to life
health care system, but eliminating insurance brokers is
                                                                     insurance sales. However, in late 2000, I went to
not the answer.
                                                                     work for my current employer Benefit Insurance
                                          LISA SPRING
                                                                     Marketing as an employee benefit adviser. I can tell
                                                                     you without hesitation that I love my job. I am cur-
My clients need my assistance in navigating many                     rently the benefit advisor for over 250 employers
solutions to their workforce needs. Whether it is                    ranging in size from two to 600 employees.
negotiating the cost of insurance, assisting their HR
department and employees/family members under-                       Our clients have a lot of choices when it comes to
stand and/or correctly manage claims, manage com-                    getting help with their employee benefit advice. But,
pliance issues, providing workforce communication                    as a successful adviser, I have built an outstanding
materials or just helping plan the budget for insur-                 team around me that dives deeper than merely help-
ance/workforce expenses, each employer client                        ing them pick a plan and a carrier. We help our


                                                                39
                    B R O K E R S         M A K I N G            A     D I F F E R E N C E



clients truly understand what they want from their             We are not your typical salespeople. We go to the
benefit package over a multiple year approach, not             hospital after a child has been born to add them to
merely making decisions twelve months at a time.               an employee’s health plan. If it is more cost effective,
                                                               we go back in a week or two to the client’s house
The one item that separates BIM from the rest is our           and help them move that child to an individual plan
attention to detail. The best health insurance plan            if it will save them money. We meet with our clients
in the world will not be perceived as superior if it is        every year to discuss renewal options, no matter
not effectively communicated to employees. We                  how large or small the client might be. We handle
constantly see employers spend hundreds of thou-               claims issues, we handle billing issues, we enroll
sands of dollars on employee benefits then simply              new hires, we provide COBRA administration, we
toss out the information never explaining how the              provide benefit fairs and we even provide cookies at
plans work or the true investment dollars made by              Christmas for all of our group clients. We check in
the employer.                                                  with our clients throughout the year just to see what
                                                               we can do to help. A large portion of our time is
We partner with our clients to:                                spent helping our clients understand new govern-
• Negotiate coverage and contracts                             ment regulations and what they can and cannot do
• Benchmark benefits                                           with respect to their benefit offerings.
• Assist with employee communication, includ-
   ing printing of material and running of group               It is important to note that we are the least expensive
   meetings                                                    delivery system available. We are 1099 contractors—
• Assist with claims and enrollment throughout                 insurance companies do not pay taxes on my behalf,
   the year                                                    they do not provide us with a staff, and we are not
• Find compliance partners for COBRA, HIPAA,                   paid unless we build trust with a client and they pur-
   Sec.125 and FMLA                                            chase a product. We work very hard and have to be
                                                               very knowledgeable to stay at the pace the health care
BIM does not charge a fee for these services. We are           system is traveling. There is no way a governmental
compensated by the commissions that are already                agency in some far-off location could match the serv-
built into the products we manage and regulated by             ice and value we bring our clients. There is no way the
the Kentucky Department of Insurance.                          government can institute health care reform without
                                  —Jeff Truitt (KY)            the help of the agent community. We are the point of
                                                               contact for all who purchase coverage. In Louisiana,
                                                               there are 1,500 brokers for a population of 4 million.
My name is Will Chapman and I am an independ-
ent agent in Baton Rouge, LA. Our agency employs
                                                               The bottom line is that we are not salespeople. We
six licensed agents and has four additional staff
                                                               are not here to make a quick buck. We have devel-
members. We specialize in small group (two-50 em-
                                                               oped long-lasting relationships and our clients de-
ployees) and individual health insurance.
                                                               pend on us. They know they can rely on us to do
                                                               what we say and deliver what we promise.
Anyone who believes that brokers only sell a prod-
uct should come spend a week in our agency and
                                                               I appreciate your time and hope to be serving my
see the real deal. Ninety percent of our time is spent
                                                               clients a year from now after health care reform takes
servicing our clients with 10% left for prospecting.
                                                               shape and for many years to come!
While prospecting, we are educating new clients on
                                                                                             —Will Chapman (LA)
the best solutions available to fit their needs on a
whole host of products (HSA, HRA, PPO, HMO,
POS, Medicare Part C and D, Dental, Disability, Life,
Section 125 plans, COBRA administration). We do
not sell—we educate and then we advise.

                                                          40
                                        G R O U P          M A R K E T



Companies need to focus on their business, yet reg-            We have extensive industry knowledge from a de-
ulations, reporting requirements, compliance issues            sign, benefit, pricing and care perspective. Our
and legislative changes take up more and more of               clients can not afford to have this level of expertise
businesses and HR’s time and resources, at a cost to           in-house and simply do not have the time that it re-
the company and to the economy. Lost-opportunity               quires to administer a comprehensive, compliant
costs increase overhead costs.                                 benefits package to their employees.

At TBR Associates, we help mitigate these costs. We            We are that resource and support.
are the resource, the tool and the means that allow                                     —Tina Lee Wright (MA)
our clients to understand, implement and comply
with new laws and legislation.
                                                               The Insurance Exchange (TIE) to the rescue, wow! Deal-
                                                               ing with insurance has gone from a complete nightmare
The new COBRA subsidy is costing companies un-
                                                               to a realistic dream. Professional advice came just in time
told millions in lost man hours trying to review, un-
                                                               ensuring we had adequate insurance in place comple-
derstand and implement it. We have provided our
                                                               menting the recent changes within the industry and
clients with the overview, explanation tools and re-
                                                               workforce. The integrity of their customer service is ex-
sources to comply as simply and quickly as possi-
                                                               cellent and is achieved by being prompt and courteous
ble, so they can focus on other concerns and issues
                                                               with any of our inquiries. For me personally and for a
knowing that they have the support and informa-
                                                               nonprofit organization with limited resources, this was
tion available to comply.
                                                               a big change, and any doubts for making the switch to
                                                               TIE were quickly subdued! Thank you TIE for everything
Our clients look to us for the answers that they don’t
                                                               that you have done!
have time to research.
                                                                                                  PETER DONAGHY

They have limited resources so we become their extra
hand. We develop communication and education not               Thanks to TIE, the employee benefits program at my
just at open enrollment but throughout the year on             company is far superior to anything we had in the past.
wellness programs, tax advantage programs, trends, etc.        They offer great service and work hard on our behalf to
                                                               deliver great value to our organization. They come with
We also provide the day-to-day answers for claims,             our highest recommendation.
contract, and service issues.                                                                       DAVE MARTONE

We work directly with the client and the employee
                                                               Tina & Michelle,
on difficult claim issues. Most recently, we helped a
                                                               Both of you and The Insurance Exchange have constantly
critically ill family member review their benefit op-
                                                               rendered my company (and me personally) excellent
tions assessing all of the medical services they might
                                                               service in every regard. It is the personal touch and
need and comparing their options to help make the
                                                               friendliness that really makes the big difference. Your help
most appropriate choice from both a coverage and a
                                                               is always there for me, even when I get things confused.
cost perspective.
                                                                                              CHARLIE MCMAHON

We helped a family with a suicidal teenage son get                                            —Rebecca Fuller (MD)
the immediate treatment and admission to a facility
he needed—on a Friday afternoon.
                                                               Our agency is a small agency with locations
                                                               throughout the state of Maine. Our state is rural in
We helped the parent of a son critically injured at
                                                               nature and small in population, which gives us lim-
school coordinate his care and get him the added
                                                               ited access to health carriers. We work with ap-
services he needed.
                                                               proximately 200 businesses, predominately small

                                                          41
                    B R O K E R S          M A K I N G          A     D I F F E R E N C E



businesses (one to 50 lives). The carriers that we do         improving the health of our workforce. From simple
have in Maine generally do not have any local rep-            claims such as lens reimbursement requests, to the
resentation for employees who can be on-site to as-           analysis of 10-year trends in claims for prescription
sist businesses with enrollment and service/support.          use, we help our clients in every avenue possible.
Our home office is located in Presque Isle, Maine.
Presque Isle is 30 minutes from the Canadian border           Our firm has just celebrated its 30th anniversary. We
and close to eight hours north of Boston. This is an          work and live in the communities we serve. We pay
area where business growth is very limited. Not               taxes, buy locally and support those who are in
many carriers or agencies are looking to open their           need. We place a strong emphasis on giving back to
doors for an office that would serve the largest town         the communities that have made our growth a suc-
with a population of only 8,800 people. But all these         cess. Our clients truly value the role we play in help-
citizens still need assistance and guidance and that          ing them navigating through the ordeal that health
is where our firm plays a role.                               insurance has become. They truly feel they have an
                                                              advocate working on their behalf and providing the
   Our clients rely heavily on our staff for advice           expertise with integrity that they would otherwise
   and assistance. The health insurance market-               not have without a local broker.
   place has become so complicated with                                                      —Scott Boucher (ME)
   changes in legislation, plan design and bene-
   fit offerings that it has become a full time job
                                                              I’ll be the first to say that the brokers Infinisource
   for a person to be well-versed in all aspects of
                                                              works with are bar none. Our brokers care enough
   the industry. A small “Mom and Pop” shop
                                                              about their clients to tell them what their liability is
   just does not have the resources or abilities
                                                              regarding COBRA, HIPAA, CDHC, enrollment, eligi-
   to take this on by themselves. They rely on our
                                                              bility, FMLA, payroll and other miscellaneous benefit
   office for services that they would not receive
                                                              laws. They care enough to partner with a reputable
   from the carrier or through any form of
                                                              vendor to provide education and back-end adminis-
   state/federal agency. We can provide an inde-
                                                              tration to their clients. Many of our broker partners
   pendent review of their benefits and shop
                                                              do reporting to us for their client’s activity on the
   their plan to ensure they are still receiving the
                                                              above laws. Some of our brokers provide HR services
   most competitive options available.
                                                              to their clients who can’t afford actual HR depart-
                                                              ments. Our brokers pay for seminars and webinars for
But our role goes way beyond the annual renewal
                                                              their clients to learn what is expected of employers to
cycle. Our firm is heavily focused on day-to-day
                                                              comply with the aforementioned laws. Infinisource,
service. We direct our clients to contact our firm di-
                                                              Inc. would not be the successful, national company
rectly with any questions and concerns. This is avail-
                                                              we are today without the support of our broker part-
able to all employees of a business, not just the
                                                              ners. When news of ARRA broke, our brokers were
owners. Most people are very hesitant to reach out
                                                              calling us at all hours to glean accurate information
to an out of state and sometimes out of country 1-
                                                              for their clients who were so concerned about what
800 number for help. Frustration from not being
                                                              ARRA meant to them.
able to understand the person on the other end of
the phone or speaking to someone who is not fa-
                                                              I’ll speak on behalf of most of our 15,000+ clients
miliar with our limited rural environment can be a
                                                              and say that their level of compliance with many of
major roadblock. We handle items such as assisting
                                                              these laws today is because their broker cared
a person with navigating through the piles of expla-
                                                              enough about them to do something to help!
nation of benefits and balance billing issues they
                                                                                     —Karen L. Kirkpatrick (MI)
may be receiving while receiving treatment for can-
cer. We assist employers in the area in the establish-
ment of wellness programs with the goal of


                                                         42
                                           G R O U P          M A R K E T



I have two stories that I’d like to share in hopes of fur-            ment will improve both the client’s cash flow
thering the understanding of the agent’s role in deliv-               and delivery of services to employees.
ering health care solutions to clients. I trust this will                                   —James M. Kenyon (MI)
help dispel the belief that all we do is “sell something.”
                                                                  I have 175 employer-group clients, mainly consisting
1. Claim Advocacy - A male employee of one
                                                                  of groups with less than 10 employees. This subset of
   client was diagnosed with prostate cancer and
                                                                  employers is desperate for help in navigating through
   was advised by his health plan that the ap-
                                                                  the whole system of providing benefits to their em-
   proved service was a traditional surgical proce-
                                                                  ployees. Most of these folks wear multiple hats and
   dure. After considerable research with my help,
                                                                  have had no training in human resources. They call
   the employee discovered that an alternate serv-
                                                                  me with every little question that arises and it gener-
   ice utilizing a laser devise was both available
                                                                  ally starts with “I have an employee that...” I am al-
   (though out-of-network) and preferred over the
                                                                  ways happy to help them with the problem, no matter
   traditional scalpel approach. The employee,
                                                                  how small, and they are exceedingly thankful for my
   armed with his new found information, fearing
                                                                  help. I have a very satisfying job in that respect. If I
   for his life and understanding that the laser
                                                                  was not there to help these folks, I am convinced they
   service would create less blood loss, a faster re-
                                                                  would simply throw up their hands and drop all ben-
   turn to work, a better outcome, and less pain
                                                                  efits. They just do not have the time to know all the
   had the service performed anyway. I subse-
                                                                  laws and regulations that consume our industry.
   quently assisted him with his claim denial ap-
                                                                                                      —Joan Kohl (MN)
   peal. With convincing statistical evidence, my
   personal efforts to convince the carrier that the
   “standard of care” was not an invasive proce-                  I have been an agent for 35 years. In the past five
   dure but, in fact, the non-invasive laser proce-               years, I have seen my role as an agent get much more
   dure proved successful. The carrier agreed to                  complex and more demanding for my clients with
   pay for the out-of-area service making the em-                 no increase in commissions.
   ployer (who was prepared to “self-fund” the
   claim) extremely happy, the employee grateful                  As an agent, I answer questions and meet the needs
   for my help and leaving me with the immense                    for the uninsured, employer groups large and small,
   satisfaction that I had a hand in helping a man                employees contacting me, low income individuals
   regain hope that his medical diagnosis was not                 asking for advice and where to turn (no compensa-
   an immediate death sentence.                                   tion on this one – I do it as a public service), indi-
                                                                  viduals and seniors. I am an educator, consultant
2. Administrative Advocacy – I have a client com-                 and counselor, benefits translator, a client advocate,
   posed of seven nursing homes whose primary                     financier for health care and negotiator.
   source of revenue is Medicaid. Revenue from
   the state normally arrives around the 20th of the              I work with the government, insurance companies
   month and unfortunately, the prepaid health                    and providers of health care. In the past five years,
   plan premium is due on the first of the month.                 my role has increased drastically. I have become the
   This client is continually in a delinquent pay-                point person for my clients in all areas in health care.
   ment position, which causes employees to be                    It is not just selling the client and walking away and
   denied medical services as the providers’ online               saying ’see you next year at renewal’—it is working
   eligibility systems advises that coverage is not               with all people on their health care insurance and
   in effect. Through our advocacy, we have re-                   needs on a day-to-day basis.
   quested an exception to standard procedures                                              —Sandra J. Neutzling (MN)
   and received approval from the carrier to
   change payment due dates from the 1st of the
   month to the 20th of the month. This agree-

                                                             43
                       B R O K E R S            M A K I N G               A    D I F F E R E N C E



We value the services our insurance broker and their                   The health care arena has become so complicated that
staff perform on our account. If it were not for their help            businesses of all sizes need representation in this intense
we would not be able to afford to offer insurance to our               industry. The committed leadership of an insurance bro-
employees. They help our company get the most afford-                  ker is paramount in providing information, education
able and most beneficial insurance plan available. They                and advice as we in the corporate setting strive to provide
are able to allow us to offer more than one insurance                  the very best benefits possible to our employees at a rea-
plan to our employees. They are always available to offer              sonable cost.
advice when needed and answer any questions we may
have. They have extensive training to maintain the abil-               Additionally, the insurance broker provides year-round
ity to offer all their services and expertise. We have had             assistance with issues like tracking and correcting em-
the same broker for over ten years. I would highly rec-                ployees’ claims which may not have been processed cor-
ommend Hairston, Johnson and Associates to help you                    rectly, assisting the corporate benefits representative with
with your insurance needs.                                             paperwork arising from open enrollment, providing en-
                                              SHARON O.                rollment materials, making presentations at open en-
                                                                       rollment, being available to walk the benefits
                                                                       representative through any corporate benefits issues, etc.
As a private small business with less than 25 employees for
                                                                       Without brokers all of these tasks would fall on the com-
the past 25 years, we have seen a lot of changes in the work-
                                                                       pany and, more often than not, an individual who knows
place and as business owners we have tried to keep abreast
                                                                       just enough about insurance matters to be dangerous to
on public policy, the latest trends, etc. As a small organiza-
                                                                       the company’s benefits’ program and the health of the
tion, we do not have HR people on staff. What very little I
                                                                       company’s bank account.
knew about insurance to begin with was probably quite ev-
ident to our agent. But without her there to answer the ques-
                                                                       Lastly, we do not need the federal government in the in-
tions I thought to ask or needed to ask and to take care of the
                                                                       surance industry period! Medicare, Medicaid and Social
ones I didn’t know to ask or didn’t understand to ask, I
                                                                       Security should be proof enough of that.
would have been in lots of trouble early on. For that very
                                                                                                                       DORIS P.
reason we have stayed with her throughout the years and
trusted her to look out for us and our interests.
                                                                       My story is simple. As a producer for life/accident
Knowing us as well as she does, we knew she would watch                health insurance, I have worked in the group health
out for us and understand our intent was to provide some               insurance arena for over 20 years, and I feel the key
form of health insurance for the employees that we could               to this industry is helping people, and educating
at a minimal cost for everyone. In spite of the rising costs           them about their insurance and the legislation that
in the industry, she has helped us achieve that.                       directly affects their lives.

So with a hat tipped in thank you, I don’t know how I                  I was recently speaking with my aunt who had been
would have ever waded through all of the red tape and                  recently laid off from a construction firm. She stated
“insurance” jargon without her there to patiently explain              that she did not have any coverage because she
(over and over again, every year) and to have her and                  could not afford the COBRA coverage that was being
her staff answer my “important” (to me anyway) in-                     offered, and could not get an individual policy be-
quiries at a moment’s notice. I appreciate it all. I have              cause of her current health conditions. She was not
enough trouble just trying to figure out my own personal               notified of the change for COBRA in which her em-
income tax!                                                            ployer would pay 65% of the premium if laid off due
                                                  ELAINE D.            to a slow down in the economy. Luckily, I was able
                                                                       to inform her of her rights within the time limita-
                                                                       tions concerning this COBRA change. She has since
                                                                       contacted her employer and is currently covered
                                                                       under her employer’s group (COBRA) plan until

                                                                  44
                                        G R O U P          M A R K E T



business picks back up. This will also keep her from           room empty for three hours. The inconvenience and
having a gap in coverage for the pre-existing condi-           frustration would have been unbearable.
tions she has.
                                                               Lisa and her husband Bruce are testimony to the
All of the new legislation being presented makes it            value a broker brings to the process.
even harder for small employers and employees to                                         —Michael R. Gross (MO)
keep up with everything. Producers play a vital role
in educating their clients in so many ways.
                                                               My mother has been an insurance agent for many
                     —Shelly Murrill-Dotson (MO)
                                                               years. And like her, I started at the bottom—answering
                                                               phones, filing, entering individual policies into the sys-
My clients, Bruce and Lisa Doctor, are the owners of           tem, and learning the business from the bottom up. I
a small business named Doctor’s Lawn & Landscape.              soon found out that many of my notions of industry in
They employ about 18 full-time and some part-                  general, the health insurance industry, and the job of an
time/seasonal employees.                                       independent agent were quite wrong.

At one point, Lisa was experiencing problems with              As a health insurance agent, I understand our role of
her back. She saw a number of providers and finally            working for our clients and negotiating with insurance
decided on a surgical procedure to correct the issue.          carriers for the best price for the best benefits for our
The physician she selected was located in a facility           clients. I get new cases and keep those clients by show-
about 1000 miles from where she resides. She called            ing them a new carrier or plan design which will ei-
with questions about plan design, in-network dis-              ther save them money on their existing benefits,
counts, etc. I explained the process she would need            provide them with better benefits for the same money,
to go through to “pre-certify” the procedure.                  or on some heavenly occasions, accomplish both.
                                                               Some businesses just starting a benefit plan will also
On a Thursday at 3:00 p.m., she called my office               call us or be referred to us for help in this process.
while she was undergoing the registration process at           These are the main ways I get new accounts.
the facility and scheduled to have the procedure the
next morning at 7:00 a.m. She had just been told               Either way, my job is to then educate the employer’s
the hospital did not have an authorization number              representative, usually an office manager or CFO,
from the insurance carrier. Lisa and her husband               about their particular carrier, plan design, or group
had been on the phone for an hour with the insur-              health insurance in general. I then present the ben-
ance carrier and there was no resolution in sight.             efit plan to the employees, enroll those who are in-
                                                               terested, compile their paperwork and submit all the
I started problem-solving based on my thirty years             information to the carrier. I also enter all the infor-
in the business. I verified what steps had been taken,         mation into my own database to monitor employee
determined what needed to be done, contacted the               changes and movements throughout the years. I also
provider, facility and carrier. In a conference call we        work with the employer throughout the benefit year
were able to resolve the issue and obtain the neces-           on the constant changes with carriers and the regu-
sary authorization number from the carrier.                    lation of the insurance industry.

Lisa had the procedure the next morning at the                 Once a year, the insurance carriers review the price
scheduled time.                                                they are charging each individual case. For every ac-
                                                               count and every renewal, we study the market to
Without the help of a broker, Lisa and her husband             make sure the current carrier and current plan de-
would have been forced to return home without the              sign best suits each client’s needs. This can be a frus-
procedure. They would have incurred additional ex-             trating process because we cannot always shield
penses and the providers would have had an operating           clients from continually rising costs.

                                                          45
                     B R O K E R S          M A K I N G             A     D I F F E R E N C E



This is a personal business. We are involved with these           Most Fridays, I go home tired and rarely do anything
people and their families. It’s not just about the num-           social because my job wears me out. But five to ten
bers, even though a large part of my job is protecting            Saturdays a year, I find myself stopping by the of-
my client’s money and finding them the most cost-ef-              fice just to “check on things.” I’ve enjoyed other ca-
fective solutions for their needs. This job can be ex-            reers I’ve led, but somehow, it does make it a little
hausting, frustrating, and even heart-breaking as we              more special for me to look on the door to my office
are involved in the business community and people’s               and see the name Mobley Insurance. And to borrow
lives. And much of that is not pretty at all, especially          a phrase from a fellow agent who was describing one
when doctors, hospitals and health care are involved.             of those Saturday visits when the office is quiet and
                                                                  no one else is there, “It ain’t much, but it’s mine.”
   The second case I ever wrote was for a lumber                  And that’s how I feel about this business and my
   company down in southern Mississippi. I met                    place of work. It ain’t much, but it’s mine.
   with the owner and showed him a plan with a                                                 —Dennis Mobley (MS)
   new carrier that would save him $40,000 a
   year. He was a retired CPA who bought a log-
                                                                  My secretary and co-agent and I have spent count-
   ging company somewhere in his career that
                                                                  less hours with laid-off employees trying to help
   became the family business for his son, daugh-
                                                                  guide them through the new COBRA changes and
   ter and son-in-law. On seeing this new plan
                                                                  the state of NC’s high risk pool. I’m talking about
   and the savings generated, he commented, “Do
                                                                  probably 10 hours per person, on average. Addi-
   you know how much work we have to put in to
                                                                  tionally, we have had to fax and re-fax information
   make that kind of money?” It felt good to be
                                                                  that was on the application that we submitted. Let’s
   able to do something for a man like him—a
                                                                  talk about the compensation that I get as the agent
   man I respect. When I was packing up my stuff
                                                                  of small groups. I feel responsible for helping these
   to leave and head back to the office, I thought
                                                                  people, but I don’t get compensated for the hours
   to myself, I like this job.
                                                                  and hours of education and assistance that we try to
                                                                  provide. I live in a textile community where, like
   After two years of having that case,I’ve kept them
                                                                  everywhere else, the layoffs are endless and workers
   under their costs when I took over the case—
                                                                  are getting little education and assistance from HR
   even with them incurring $40,000 more in claims
                                                                  departments. We realize that these employers have
   than they paid in premium the first year. I had to
                                                                  to meet the “bottom line” or close the doors, so we
   use every tool in my toolbox for that one. But
                                                                  become their HR and counseling departments.
   that’s also why we spend 20-30 hours per year in
                                                                                           —Omegia W. Seaford (NC)
   Continuing Education and another 40-80 hours
   per year studying new plan designs and new reg-
   ulations during long seminars at various hotels                I just spent 45 minutes on the phone explaining HSAs
   and such—to be able to provide the kind of ex-                 to a small business owner. My clients call me daily with
   pertise that I was able to with my lumber com-                 questions regarding claims, renewals and administra-
   pany. My mom always says,“If this job were easy,               tion. At renewal time, I do not know how a group
   everyone would do it.” And she’s right.                        would be able to get the help they need with plan
                                                                  changes and carrier quoting. I truly believe that we
But there is also a cost. I face job-security threats from        make our clients’ lives much easier and without us,
the political situation both in my home state of Missis-          they would have much less time to do their work and
sippi and at the federal level. Competition is what               most likely many more claims would be left unpaid.
keeps us in the game. Changes in the economy, com-                                        —Stephen de Gersdorff (NJ)
petition within the agent community, and our own per-
sonal challenges constantly keep us on our toes.



                                                             46
                                         G R O U P          M A R K E T



I am an independent broker based in Albuquerque,                small employers in general do not have HR depart-
NM. We are most certainly a small employer state,               ments. When it comes to insurance, they rely on their
and the majority of my clients have less than 20 em-            insurance professional for advice. When it comes to
ployees. In almost all cases, there is not a designated         taxes, they rely on their accountant for advice etc. My
human resources professional. The same person fre-              clients rely on me for many things. I do not just sell a
quently wears many hats: HR, benefits, payroll, etc.            policy. I educate and I provide outstanding service.
I see my functional role as a member of their man-
agement team. I assist daily with enrollment issues,            When my small-business clients (less than 20 em-
questions on eligibility, resolution of claim issues,           ployees) began to look at the Health Savings Account
guidance on where to find data on compliance is-                concept, not only did I educate them about all aspects
sues (Medicare, HIPAA, SCHIP, COBRA, etc.).                     of the idea, I met with and explained every detail to
                                                                the employees. I provide a service that can never be
My clients know that I am their “go to” person when             matched by a website or a government employee on
these issues arise. They have businesses to run! I              the other end of the phone. Once a policy is in force,
save them an enormous amount of time and re-                    my job continues with follow-up questions and other
sources by always being available. In a nutshell, they          service. When a small business owner needs to add a
know that if they call me, I either have the answer or          new employee, who does he call? He or she would be
know where to find it. If brokers are “factored out of          overwhelmed without my presence. What forms are
the equation” in the health care reform process,                required? Where do I mail them? When does my new
where will these employers go for help?                         employee become eligible? Where is the information I
                              —Kevin Pelletier (NM)             need to explain the coverage?

                                                                Guess who provides these answers and services? Ei-
As a life and health insurance broker in small town
                                                                ther myself or someone on my staff. Yes, they could
New Hampshire, I can confidently say that I have
                                                                call the insurance company. But what level of serv-
been providing my clients with valuable informa-
                                                                ice can the company provide over the phone? What
tion, professional opinion and outstanding customer
                                                                added incentive do they have to offer the highest
service for over two decades.
                                                                level of customer service?
My individual and small-group clients are not sold
                                                                I could go on and on about the value added by local
insurance. In the end, they make an educated deci-
                                                                insurance professionals like myself. I have spent 25
sion to purchase a health insurance policy that best
                                                                years educating myself so that I can provide insur-
suits their needs. When I am asked to consult with
                                                                ance expertise to my community. Any change to the
someone regarding their needs, or the needs of their
                                                                marketplace must include the valuable services of
employees, I begin by asking questions. Once I am
                                                                local insurance professionals in order to be effective.
educated about their needs, I shop the insurance
                                                                                            —George G. Curt (NH)
market for them and prepare a spreadsheet of costs
and benefits of the various options.
                                                                We are an employee benefits consulting firm in Min-
When my homework is done, I schedule a meeting                  neapolis, MN. We specialize in helping small,
and begin to educate my prospective client. I review            medium, and large employers throughout the coun-
everything from the cost factors to the state and fed-          try design, implement, and administer their health
eral laws that affect their coverage. Most consumers            and welfare plans for their employees. These em-
are so busy with daily life and do not understand why           ployers have hired us to provide these services.
health care costs are so high or what choices they have.        Without our assistance they would simply be buying
Most small business owners have no idea how to ad-              a product from an insurance carrier and paying a
minister COBRA (or the state continuation). Some do             premium. We help our clients negotiate with the in-
not even know what it is. Small town America and                surance carriers to customize a benefits package that

                                                           47
                     B R O K E R S          M A K I N G              A    D I F F E R E N C E



works uniquely for their business model. Our clients              in their various locations. We determined which in-
appreciate our expertise, our ability to provide mul-             surers/HMOs would deliver the best care/benefits to
tiple insurance carrier options and communicate                   their employees. Detailed geo-access studies were
these benefits through meetings to the employees,                 performed to ensure proximity of providers in their
handle administrative items, and more.                            residence/work areas. The self-insured plan was ter-
                                                                  minated and all employees enrolled in local man-
We are sending you several case studies of some of                aged care plans for their location. This involved
the clients we have worked with over the last 30                  using 15 different contracts with 11 insurer/HMOs
years while in business.                                          for just the medical and dental plans. We were able
                                                                  to install first class plans with added first dollar ben-
We believe in a private health care marketplace since             efits in each location. RAM continues to manage the
it provides competition and thus provides better re-              enrollment process by making presentations on-site
sults for employers and employees.                                each year. Presentations are currently made in Eng-
                                                                  lish, Spanish, Polish and two Chinese dialects. Re-
MULTI LOCATION, NON-STANDARD                                      sponsibilities for eligibility, enrollment, and billing
SOLUTION                                                          functions/responsibilities were then moved to RAM.
                                                                  Two senior customer service coordinators (CSC)
Challenge                                                         were assigned to manage the process and to handle
This company manages three- and four-star hotels in               all service-related issues. Audits are conducted peri-
several major cities. Each hotel averages 250 employ-             odically and premium savings have occurred
ees. The central corporate staff does not maintain HR             through close management of the employee benefit
staff or training to effectively operate their complex            termination process. The controllers and human re-
benefit programs. Their previous health plan was self-            source directors now have outside help in the mon-
insured and costs were out of control. Budgets were in            itoring of premium adjustments, benefits, and
disarray with each hotel as its own cost center. The              insurance carrier service issues. The RAM CSC’s
medical benefit plan was weak, poorly understood,                 serve as the hotel’s first call for help. We added the
and not competitive with other hotels. At some of the             benefitsCONNECT HRIS system to centralize cov-
hotels, paymasters who had not been trained in em-                erage and eligibility information. The CSC’s are
ployee benefit programs were tasked to handle hotel               responsible for all updates to the system – including
benefits. Benefits are a secondary function with payroll          additions to the system, coverage changes, and ter-
being their primary responsibility, and they reported             minations. The hotels each have access to view all
to the controller, not to the HR Director. There was no           employee information to verify any questions that
central repository for all critical forms and records. The        they may have regarding coverage or personal
hotels were not capturing the provider discounts avail-           changes. RAM receives payroll data feeds and sub-
able in their region, specifically for their health/dental        mits all changes either online or via Electronic Data
plans. They needed experienced personnel to solve                 Interchange (EDI). The 401(k)-plan administrator
claim/billing problems with various insurers and                  was replaced and new account options were in-
providers. As with most hotels, high turnover of per-             stalled. RAM has the primary role in improved em-
sonnel presented a problem in administration. The per-            ployee communications to satisfy IRC Sec 404c
formance of the 401(k) plan was poor, and the                     exemption requirements. RAM hosts all record-
employees were having difficulty understanding the                keeping functions, and we have a duplicate set off-
plan. On average, English was a second language for               site. The corporate headquarters has not had to add
60% of the employees. The CEO expected the VP of                  any staff, and RAM has become their outsourced HR
Human Resources to manage corporate HR issues and                 department for all employee benefits.
not to be tied up with benefit issues.
                                                                  Results
Solution                                                          RAM was able to document savings of one million dol-
RAM’s work began with defining available insurers                 lars in each of the first two years, which equates to a

                                                             48
                                             G R O U P           M A R K E T



21% savings. Through skillful marketing and negoti-                  Fortunately, the claim liability was not an issue because
ations, RAM has been able to keep the hotel’s cost at                their claims went down when they changed vendors.
the low end of the market while delivering the high-
est quality benefits possible. Budgets are now more                  SIGNIFICANT ACQUISTION
predictable and RAM’s forecasts have been within five
percent of actual renewal rates. We’ve streamlined the               Challenge
benefits administration process for each hotel; reduc-               Christensen Family Farms, a family-owned business in
ing the time it takes for them to manage employee el-                the pork production industry, recently acquired another
igibility, enrollment, and billing. Employee satisfaction            smaller business. As a standard practice, they would ab-
is very high. Accor management resources are now                     sorb all of the new company’s employees into their
free to concentrate on other essential functions. All of             plans. However, if these new people were to be rolled
this has been accomplished at no direct cost to the                  into their medical plan, their current medical insurance
company or the hotels.                                               vendor would have the ability to re-rate the entire med-
                                                                     ical plan. This would be a problem since the losses in
Poor Service with an Ongoing                                         the current year would cause a very significant increase.
Large Claim
                                                                     Solution
Challenge                                                            RAM Benefits did an overall analysis of the benefits
Buffalo Wild Wings was self-insured with a vendor that               as part of the due diligence process. While the plan of
had high fixed costs and underwent a claim office con-               the acquired plan was not exactly the same as that of
version. As a result of the conversion, people would be              Christensen Family Farms, it did pass a comparabil-
randomly dropped from the plan, or people would just                 ity test. That test states that if the plans are actuarially
show up on the plan. Others would have to be entered                 similar, there is not a discrimination issue. Therefore,
several times. Compounding the problem of finding a                  we recommended that Christensen Family Farms
new vendor to pay their claims was the fact that there               keep both plans until the main plan renewed. At that
was a major ongoing claim that caused stop-loss carri-               time, a cost evaluation will show whether it makes
ers to decline to offer coverage.                                    sense to merge the two plans.

Solution                                                             Result
After a complete marketing, RAM Benefits did the fi-                 By taking their time and not using the quick and
nancial analysis and determined that if we could con-                easy solution, Christensen Family Farms saved more
vince a quality carrier to quote stop-loss and exclude               than $500,000 between January and July.
this claim, the financial savings due to lowering the
fixed costs would more than cover the expected costs                 Networks and Their Discounts
for the large claim. We then negotiated directly with
the underwriter of a major stop-loss company. They                   Challenge
agreed to exclude the first $35,000 in claims over the               Douglas Machine, like many large employers, expe-
specific stop-loss level on this individual even though              rienced a large increase in their medical claims. They
it is against their policy. All future claims would not              were very happy with their current vendor but had
be subject to this type of exclusion.                                not undergone a major marketing anaylsis in several
                                                                     years. The projected cost increase was $435,000.
Result
Buffalo Wild Wings was able to move to a new third                   Solution
party administrator, solve their eligibility issues, continue        RAM Benefits did a thorough marketing analysis of the
to offer the same networks to their employees, and save              networks available to the employees of Douglas Ma-
well over $150,000 in fixed costs. In addition, their max-           chine. We found that the marketplace for networks
imum claim liability went down by another $150,000.                  had changed drastically since Douglas Machine had


                                                                49
                    B R O K E R S        M A K I N G             A    D I F F E R E N C E



last looked. While their current network had reason-          efitsCONNECT system was completely installed and
able discounts, HMO’s had developed 10% larger dis-           ready to go live.
counts and had almost all of the local doctors and the
local hospital in their networks. We then brought our         Solution
conclusions from the marketing analysis to manage-            The company hired RAM Benefits to implement the
ment. After that meeting, we had two more meetings            benefitsCONNECT system after three meetings and
with the benefits committee. Once a decision was              an online demonstration with senior management.
made, RAM Benefits developed a presentation and ex-           The solution to their problem was straightforward.
plained all of their benefits in a series of mandatory        First, we gathered all the employee demographic
meetings with the employees of Douglas Machine.               and benefit data by extracting this data from their
                                                              ADP PC/Payroll system then uploaded the data via a
Result                                                        500 report into the benefitsCONNECT system. Sec-
The savings from changing to a HMO network was                ond, we gathered all of their benefit plan contracts,
worth $144,000. Douglas Machine also modified                 plan designs, summary data and built the plans in
their plan, made a very modest change to employee             the system. We then attached all of the benefits to
contributions, and increased their corporate contri-          the employees and entered in all dependent data
bution by $195,000. Because of the involvement of             and added all the medical, dental, life, disability, etc.
the benefits committee and the investment in com-             forms into the system. We tested this data for all sce-
munication to the employees, the plan changes were            narios. We built a company-specific open enroll-
well received.                                                ment and new-hire guide for employees to follow
                                                              step-by-step for their “required” online open enroll-
CONNECT SETUP FOR: BIOMEDICAL                                 ment. Then we performed four training sessions
COMPANY – 200 EMPLOYEES                                       (one virtual via the internet) for the employees to
                                                              show them how to use the system.
Challenge
We were introduced to this biotechnology client in            Results
2002. Our first meeting was with the Human Re-                Our client had all employees enrolled for their ben-
sources Director and Manager. The challenge was               efits online within a three-week period. As men-
they had multiple medical, dental, life, disability,          tioned above, the HR staff was cut from four to two
401(k), flex, etc. benefit plans and had to fill out          employees within days of our client going live on
multiple forms for new hires, any carrier/plan                benefitsCONNECT, and open enrollment. This
changes for open enrollment, life-events and more.            posed a major problem initially, but was quickly re-
Payroll was being processed through ADP, but they             solved by RAM performing in-depth advanced train-
were not tracking benefit deductions very accurately          ing sessions for the remaining two HR staff to
because of the lag in time between HR forms pro-              complete open enrollment and manage the system
cessing and payroll changes. The company was fax-             going forward. The client is now able to run their
ing forms, emailing data (un-secure PHI), and going           HR department efficiently with two staff instead of
online to multiple carriers to enter employee data.           four which equated to a savings of $160,000 per
The HR department was staffed with two highly                 year in salaries alone. Also, since the employees are
compensated HR people and two HR administrative               doing all of their own demographic and benefits
staff to manage a 200 employee company. The CEO,              changes via benefitsCONNECT the managers are
CFO, and management team wanted a solution to                 able to perform other duties. This employee self-ser-
reduce the HR department or paper-based enroll-               vice (ESS) has made the company’s Return-On-
ment and go to a web-based system. Finally, man-              Investment (ROI) a reality since the setup charge
agement thought the HR department and the                     was $5,000 and the PEPM (Per Employee Per
company as a whole had too many management                    Month) charge was $2/PEPM. The time saved in the
personnel so 25 managers, including the two senior            HR department through more efficient HR and ben-
HR managers, were fired three days before our ben-            efits practices equated to dollars savings due to less

                                                         50
                                           G R O U P          M A R K E T



staff needed to complete the work. Also, employees                Results
are now able to answer most of their own questions,               Participation in the health plan continues to be high,
thus creating more time for HR to do other tasks.                 with the lower compensated employees migrating to
This client has been using benefitsCONNECT for 2+                 the lower cost plan. Salaried employees continue to
years to date. Future technology goals are to set up              purchase the higher cost plan, but now have a better
Electronic Data Interchange (EDI) to the medical                  understanding of the true cost of the benefits. Pre-
and dental carriers, as well as set up a payroll inter-           scription drug costs decreased by over 20% and in two
face to the company ADP payroll system.                           years still have not returned to previous highs. The
                                                                  medical claims went down minimally and over two
Cost Increases and                                                years have remained flat. The benefits adjustments
Contributions                                                     have been well received and have helped Company R
                                                                  remain competitive with their competitors.
Challenge                                                                                       — Scott Haskins (MN)
Company R, a large company with approximately
2,000 full-time employees whose primary business is
                                                                  I have been a client of Linda Mackey Insurance for over
meatpacking, was facing large health care cost in-
                                                                  four years and she is one of the most knowledgeable and
creases and their prescription drug costs were rapidly
                                                                  dedicated insurance brokers I have ever worked with. In
rising. In addition, a large percentage of the employ-
                                                                  today’s economy of ever-rising health insurance premiums
ees were working in the U.S. via their green cards and
                                                                  Linda has always provided me with high quality and cost-
did not highly value their benefits, even though the
                                                                  effective health insurance options for my company. The staff
employee cost per paycheck was less than five percent
                                                                  at Linda Mackey Insurance provides excellent customer
of the total cost. Some of the employees paid nothing
                                                                  service and truly understands an organization’s challenge to
for insurance. However, if the contributions were dras-
                                                                  provide quality, cost-effective insurance options to its em-
tically increased or benefits significantly decreased, the
                                                                  ployees. Linda is extremely well-versed in the benefits of
fallout from the management and office staff could
                                                                  various insurance plans, as well as industry trends and best
have disrupted business. Another challenge was the
                                                                  practices. When my organization needs quality insurance I
political ramifications of being the main employer in
                                                                  trust Linda Mackey to handle all of our insurance needs.
several smaller towns. If an employee could not afford
                                                                                                            LISA WILLIS
coverage and had large claims, the employer could be
viewed in a negative light.
                                                                  Linda,
Solution
Through a series of meetings, RAM Benefits was able               This is just a note to tell you what an outstanding job Mon-
to help develop a series of benefit and contribution              ica has done. I was having difficulty getting ID cards for
changes. Then, a team from Company R and RAM                      one of our employees. When Monica heard the message,
Benefits toured the various plants and held mandatory             she immediately put things in motion, and lo and behold,
meetings explaining national trends, industry trends,             the cards that I’d been trying to get for almost a month
and the new benefit structure. The benefit changes in-            now arrived yesterday. She did an outstanding job of cor-
cluded implementing two medical plans (vs. the pre-               recting this problem for us. You have a “diamond” in Mon-
vious singular plan) and changing the prescription                ica- kudos to her. Excellent work - absolutely excellent.
drug co-pay from a flat dollar amount to a percentage                                           MIGNON A JOHNSON
co-pay. The lower plan of benefits continued to have
a very nominal weekly contribution. In addition, the
                                                                  We opened our first World Gym location in Peachtree
dental plan enrollment was no longer tied to partici-
                                                                  City in October of 1998 with seven employees, two of
pation in the medical plan. Salary adjustments were
                                                                  whom were full-time. At that time, the ability to offer a
made to office staff on a one-time basis to account for
                                                                  group health insurance plan was not a possibility. Years
the increased contributions.
                                                                  later, as our one facility grew into three and our full-time

                                                             51
                       B R O K E R S           M A K I N G              A    D I F F E R E N C E



staff grew to fourteen, we became financially able to offer          medical testing such as bio metrics and health risk
a good quality health plan to our valued employees.                  assessments, along with health clinicians providing
                                                                     counseling for high-risk employees throughout the
I met with four different providers, one being Linda Mackey          year. Our objective is to help the employer and em-
of Linda Mackey Insurance. After looking at all of my op-            ployees reduce the number of health risks through
tions, I chose Linda Mackey Insurance for two specific rea-          changing the culture at work and high-risk behav-
sons. The first reason was that Linda “knew her stuff.” I            iors. As we reduce health risk throughout the year,
know that does not sound very professional, but that phrase          we are bringing the cost of health care back to more
pretty much sums it up. She knew that this was the first             affordable levels, which is what the employer and em-
health insurance plan that World Gym had ever been able              ployee need in order for them to continue to purchase
to offer and she made sure I understood all my options be-           health insurance for themselves and their families.
fore a decision was made. The second reason I chose Linda
Mackey Insurance was because of the comfort level Linda              Our job is a total team effort with the employer and
provided to me in making this decision. I had the opportunity        their employees.
to provide a wonderful and quite necessary benefit to our                                            —Steve Wilson (NC)
employees and I wanted it to be the best health insurance
available in regards to coverage and cost. Linda made me
                                                                     I would like to tell you one story about our agency
feel confident in my decision.
                                                                     and one about our chapter.
I would recommend Linda Mackey Insurance to any
                                                                     The first is about a large client (125 employees) that
company, large or small. Her staff has always been
                                                                     had an issue with an employee’s dependants that for
warm and friendly on the phone and eager to assist us in
                                                                     no reason were removed form the covered roles of the
any health insurance situation that occurs. Linda her-
                                                                     plan. We were able to get the kids put back on the
self is never too busy to return phone calls when she is out
                                                                     plan after a couple of calls. What we didn’t know until
of the office and makes calls to check on us as well. Our
                                                                     months later is that when the carrier’s system removed
experience with her company started in August of 2005
                                                                     the kids it also backed out all of the claims ever paid
and I look forward to many more years working with her
                                                                     for by the carrier. This caused the physician’s practices
and her staff.
                                                                     the employee’s children were seeing to go after the em-
                                         KIM HERSHEY
                                                                     ployee for all of the back charges. While we were fig-
                                                                     uring it all out the system removed them again and
As an insurance broker for employers, our job is to                  this time backed out most of the claims we had just
help educate the employer and their employees to                     had replaced by the carrier. In the meantime, one of
the parts and pieces which make up and determine                     the physician’s offices was collecting and applying the
the effectiveness of their health insurance coverage                 office co-pay incorrectly to the employee’s account. To
and the ultimate cost of coverage year after year. We                get this all figured out and settled before the employee
know that supply and demand are the major com-                       was taken to collections, our office (me) sat down with
ponents which determine the benefit level and af-                    a six-inch high stack of bills, EOBs and the employee’s
fordability status of health insurance.                              checkbook and credit card statements and created a
                                                                     spreadsheet. We then met with the carrier’s claims de-
Our job is twofold. First, we negotiate the best rates               partment and the physician’s office and assisted in get-
while matching appropriate benefit designs, along                    ting the entire thing sorted out so the correct parties
with educating consumers on how to use their                         (carrier, physician’s office, and employee) each paid
health insurance throughout the year and imple-                      the correct portion. This was a several day process and
mentation. This is only the beginning. Secondly, em-                 took hours and hours of work but we felt it was our
ployers need our hands-on services throughout the                    job to make sure the employee was not charged one
year to effectively orchestrate the demand side of                   penny they did not owe.
their healthcare. This means education, incentives,

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                                           G R O U P           M A R K E T



The second story is about members of our chapter.                  someone who can do it faster and better, while you are
North Carolina has a new high risk pool called Inclusive           making money doing what you know best.
Health. Last month, there was an “Inclusive Health Day”
at one of the large hospitals here in Raleigh. Several of          Case #4
our members gave up their day to go over to the hos-               I had a HSA client in NY who was being charged about
pital and sit down with folks that needed help working             $400 more than what the hospital charged at retail,
their way through the application process. Applying for            because the carrier he was using had some kind of
the coverage is no easy task. Not only did our members             global fee arrangement with that hospital where they
work with the people about the high risk pool but they             paid about $2000 more than what was originally
spent hours talking with people and helping them with              billed. This led to an increase in the out-of-pocket on
the new COBRA subsidy rules, Medicare and Medicaid                 his deductible and ultimately would have been a re-
questions. They were also helping train the hospital em-           sponsible payment over and above what he was obli-
ployees so they could advise people as to how to get               gated. After calls to the carrier went nowhere, I called
into the high risk pool. All of this was done simply to            my carrier rep and got it straightened out in two days.
be of service to the people of North Carolina.                     Many times the client doesn’t know what questions to
                                —Teri Gutierrez (NC)               ask or what to follow up on and so they often do not
                                                                   get what they need in a reasonable period of time.
                                                                                                  —Craig Lordigyan (NJ)
I have a lot of stories and general situations that hap-
pen every day. Here are a few that are most memorable.
                                                                   At my firm we help clients with more than renewals
Case #1                                                            and how to lower cost on health plans. Our office
A client was moving from one carrier to another. The               brings in about 60 – 65 calls a week from employ-
owner’s daughter has scoliosis and in order to get the new         ees seeking help with claims, overpayments to doc-
coverage in effect without terminating the daughter’s ben-         tors, appeals to insurance companies, etc. There is
efit due to aging out, I had to go directly to child’s spe-        no such thing as seeing your client once a year. For
cialist and get a proof of disability signed by the doctor         instance, with the new COBRA laws, my clients look
and submit it to the new carrier. The client could not do          to my office for advice, we refer them to the DOL
the same as they were traveling out of state at the time.          sites and help them find and look for the informa-
With my help, the coverage continued without a gap.                tion they need.

Case #2                                                            Employers look to their broker to help them under-
Currently, a number of our clients are being con-                  stand how and what different plans do, then have em-
sumed by the new COBRA subsidy and they need                       ployee meetings to explain to the population how
extra help. Without our assistance, they’d be lost                 their new plan works. These are just a few things we
and almost surely out of compliance.                               do on a daily basis to help the employee/employer
Case #3                                                            relationship with benefits. I do believe if my office did
Just about every client needs guidance on the typical              not bring this kind of service to our clients, we would
function of employee maintenance with regard to health             not have any clients. The relationships we have with
benefits. Whether dealing with enrollment or termina-              our clients are outstanding. It is a great feeling when
tion or continuation, there either needs to be guidance            you go visit and you get a thank you from an em-
from an employee who can learn and do all of these                 ployee for help with a claim, or are out in your
functions, including knowing how to remain compli-                 community and a client says thanks for a doing a
ant, or an insurance agent offering assistance. It would           great job.
mean more staff or manpower to handle things that
agents do more efficiently and economically. It’s like you         In my community, there is an organization called
trying to repair your own brakes on your car or hiring             Ocean of Love. It is a center for children with can-
                                                                   cer. I go to the center and help families with their


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                    B R O K E R S         M A K I N G              A      D I F F E R E N C E



claims and explain how their benefits work with                Washington who has the slightest idea as to what a
their booklets in front of me. This is what I do to            benefit broker really does. Nor do they have any idea
give back on my own time, and at the end of the day            as to the volume of paper and labor involved in
it is a great feeling that I could help.                       complying with so many regulations that are basi-
                                                               cally meaningless. I suggest they form a commission
I hope this helps you understand our job as broker,            to study all of these things from a proficiency and
consultant or advisor. The role of the broker has              practicality point of view. It would save trees, reduce
changed dramatically in the past five years and I see          employer costs and reduce the cost of health care.
more change coming forth.                                                             —A. Michael Chodorcoff (NJ)
                        —Michael Kapandais (NJ)
                                                               The following are a list of the more time-consuming
In addition to making a sale, below is a partial list-         activities that I help my customers with, in addition
ing of some of the things we do for our clients:               to the initial sale:

1. Present renewals with appropriate historical                •       Add, change and/or terminate employees – help
   data and options to meet the employer and                           fill out forms, send forms to carriers, track com-
   employee objectives                                                 pletion and provide ID numbers
                                                               •       Convert employees from active coverage to
2. Prepare 5500s                                                       continued coverage/COBRA
                                                               •       Verify carrier bills, for adjustments related
3. Prepare SARs                                                        to above
                                                               •       Provide current monthly rates (single, h/w, p/c
4. Provide model notices and assistance with                           and family) to customers
   COBRA                                                       •       Help reinstate customers who forget to pay
                                                                       their bills
5. Make sure client is aware of FMLA and ADA                   •       Verify employee enrollment, order new ID
   responsibilities                                                    cards, change primary care physician selections
                                                               •       At renewal, quote other carrier plans and alter-
6. Design employee contribution strategies                             natives with the existing carrier – help fill out
                                                                       forms, send to carrier, track completion,
7. Interact with the insured or employer to help                       provide sub/group number, term prior carrier
   resolve issues with providers, as well as federal                   (if switching)
   and state government                                        •       Review benefit designs/choices with employees
                                                                       – at renewal, conduct open enrollment, help fill
8. Assist terminated employees with their options                      out forms, send to carrier, track completion,
                                                                       verify billing adjustment
9. Assist employees with Medicare issues                       •       Review numerous claim processes with em-
                                                                       ployees (e.g. referrals, pre-certifications, pre-au-
10. Integrate with other employee benefit plans                        thorizations, Rx quantity limits, etc.)
                                                               •       Intercede for employees when they have vari-
11. Give advice on all issues surrounding their plan                   ous problems with claim processes (e.g. denials,
    including governmental requirements                                adjustments)
                                                               •       Educate employers on many questions about all
12. Present wellness initiatives to help improve the                   of the above
    health of employees                                                                               —Greg Colen (NJ)

I could go on and on. I doubt if there is politician in

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                                        G R O U P          M A R K E T



Here at the OSSA Group, we have been designing,                In summary, we as brokers become a source of ad-
implementing and servicing employee benefit pack-              ministration and information for our clients.
ages (Medical, Dental, STD, LTD, Life & 401(k)’s)                                          —Joseph Marini (NJ)
for more than 20 years. Once a benefit is sold and a
contract is signed, the real work begins, starting with
                                                               My name is Jamie Clark. I am the VP/CFO of Paul
employee meetings to explain the benefit package
                                                               Clark Ford-Mercury, Inc. in Yulee, Florida. As many of
in detail and answer any questions employees may
                                                               you are well aware, the past year and a half have been
have. Once the plan is up and running, each em-
                                                               trying times in the automotive industry. It’s been a test of
ployee has our number to call our office or e-mail
                                                               our faith and resolve, to say the least.
our office for any service-related problems and ben-
efit questions. These problems range from claim is-
                                                               Being a small- to medium-sized automobile dealership,
sues to finding a participating provider to assisting
                                                               it is difficult enough just simply making sure that the
an employee in an appeal process. Yes, the insurer
                                                               business runs as smoothly as possible. Without the guid-
has a customer service number to call but more fre-
                                                               ance of our group health & group dental agent, it would
quently than not it turns out to be a time consum-
                                                               be impossible to ensure that we complied properly with
ing task for the employee to deal with the insurer’s
                                                               the rules and regulations set before us. Not only do they
service department and often the insurer’s service
                                                               provide us with the best options to choose from in terms
representatives give incorrect or incomplete answers
                                                               of policies, they also ensure that from billings and claims
to the caller. Claim problems can be complicated
                                                               to COBRA that we are doing all that we are required to
and time consuming because the problem can occur
                                                               do and they go above and beyond even that in assisting
at various sources (provider’s office, insurer, insured
                                                               our employees when they have individual needs relating
not following proper procedures).
                                                               to their group health or dental.
On the employer side, we communicate with either
                                                               Personally, I can give you numerous examples of how
an HR director/CFO/Controller on a regular basis to
                                                               they provided me and my family with sound, professional
resolve problems, answer questions or recommend
                                                               assistance when I had neither the time nor the knowl-
action. For example: questions regarding whether a
                                                               edge to handle certain issues myself. At one point, we
certain service is covered under the contract and if
                                                               switched carriers and all employees began receiving no-
covered to what degree, reviewing the contract to
                                                               tices that their claims and the claims of their dependents
confirm it contains the correct benefits and provi-
                                                               were being denied. I, too, was one of those denied coverage
sions that the employer purchased, providing
                                                               under the policy we had. I made numerous attempts with
direction and interpretation of federal and state laws
                                                               the carrier to clear up this issue so that our employees would
that apply (HIPAA, COBRA, FMLA, TEFRA,
                                                               have the coverage they were paying for and that the company
Medicare, CHIP, NJMLA, NJSC, NJPFL), assisting
                                                               was paying 80% of the employee portion on their behalf;
the employer with their corporate policy manual,
                                                               however, I was unable to resolve anything. I finally contacted
making sure that the employer’s benefit package is
                                                               Tim Owen of Owen & Associates, and he immediately de-
competitive by putting the package out to bid on an
                                                               termined what the problem was. The previous carrier had
annual basis. Our larger clients utilize our office in
                                                               not deleted us from their database. They were not billing us,
various ways. Some have their new hires call our of-
                                                               just had us in as their client. Mr. Owen made the necessary
fice so we can review and explain the benefits that
                                                               phone calls, wrote the necessary letters for our company and
are available and discuss what their monthly contri-
                                                               made the issue go away. Once again, our employees could go
bution will be etc. We also do the enrollments and
                                                               to their doctors and receive the medical attention they de-
terminations for some of these clients, and set up
                                                               served. Without Tim’s knowledge and assistance, we would
and maintain employee benefit web sites. These sites
                                                               not have been able to correct the issue. What a blessing he
have all the employer’s benefits, forms, contacts, and
                                                               and his organization were to our company in that situation.
important links in one place and allow employees
24/7 access to this information and tell them how
to contact us with any questions they may have.

                                                          55
                     B R O K E R S          M A K I N G            A    D I F F E R E N C E



From a more personal standpoint, Owen & Associates               It would be a huge, huge mistake to get rid of agents/
has guided me numerous times as to the course of action          brokers! Please hear my screams of NO to voting against
to take to minimize my out-of-pocket expenditures when           agents/ brokers!!!! We, I, need them desperately!
certain procedures were required. The group has done                                             MICHELLE KRIEG
that, not only for me and my dependents, but for count-
less other employees under our company’s group health
                                                                 I have been licensed since the late 1980s, and I have
and group dental policies.
                                                                 been a broker since 1994. What I offer my clients is
                                                                 the knowledge that I will handle all their needs.
In closing, without the knowledge and assistance pro-
                                                                 Whether they have a claim issue, if it is a group, en-
vided by our agent, there is no possible way we, as a
                                                                 rolling and educating each and every new hire,
company or as individuals, could properly manage our
                                                                 keeping them informed on what is going on in the
group health or group dental benefits. A company of our
                                                                 industry by periodic newsletters via mail and now
size cannot possibly devote the resources needed to main-
                                                                 by e-mail. Employers have enough going on that the
tain this level of expertise. Our hope and prayer is that
                                                                 service of stepping in and enrolling and educating
those who read this realize the important role our agent
                                                                 their employees on their benefits is an invaluable
plays in ensuring the continuance of our business.
                                                                 service to the employer. The time it saves them is a
                                             JAMIE C.
                                                                 huge benefit, and, not to mention, the paperwork is
                                                                 handled efficiently, and the employee meets me, and
The initial sale is such a small part of what we do for          knows I am the one they need to contact. This keeps
our clients. Yes, we help them understand all the facets         private matters private, and certainly keeps expo-
of the many plans they can choose from and help                  sure to private health information out of the work-
them decide which one fits their budget and needs.               place, as much as possible. I also get as creative as
We also check on their preferred doctors so they will            possible in aiding the groups with cost-saving alter-
be able to select the correct plan. We conduct on-site           natives and options in their health benefits arena.
enrollment meetings explaining the plan to their em-             These are things that they do not, and many would
ployees and helping them enroll. We follow up with               not, be able to figure out on their own.
the insurance carrier to be sure everything is being                                           —Sherry Bender (OH)
processed properly and for some insurance companies
we, the brokers, enroll the client online and then just
                                                                 I have been in the group health insurance business
send the check and tax documents on.
                                                                 for more than 23 years. While the annual renewal
                                                                 process, carrier selection, funding arrangement, etc.
After the initial sale, we are here for all the questions
                                                                 are important for clients, it represents a fraction of
and problems. We enroll or terminate employees on-
                                                                 the time I spend with my clients.
line for our clients so they can concentrate on their
business. We provide complex service and advice
                                                                 The most recent issue I have spent time resolving with
(such as with the new COBRA subsidy). We keep cur-
                                                                 my clients is with the new ARRA COBRA law. My em-
rent on compliance issues and changes to insurance
                                                                 ployer clients have been calling us left and right to
companies and their policies and plans and rates. At
                                                                 explain the regulation. While we are not lawyers, we
renewal, we help our clients to review the market and
                                                                 can provide them with documented resources from
make the right choice for them—stay where they are,
                                                                 the IRS. Many answers are on the IRS website but it
change their plan or change their carrier.
                                                                 is impossible for the average person to navigate the
                                                                 thousands of subjects and pieces of information. One
I cannot imagine a person or company having the
                                                                 particular client who has part-time personnel is trying
time to accumulate this expertise without the help of
                                                                 to run his business but needs constant help with in-
an agent. We brokers in New York take 15 credit
                                                                 surance procedures and government regulations. An-
hours every two years just to keep sharp.
                                                                 other client has an employee whose dependent has
                            —Kathy Walczak (NY)

                                                            56
                                            G R O U P           M A R K E T



an illness that the hospital and third party payer can-             from Sandy or her staff. A couple of years ago at renewal
not seem to get straight because of a coding error. No              time, Sandy told us that we might want to look at higher
one will call her back and all she gets is the collection           deductible plans, as they would save our company a lot
agency demanding payment. The employer does not                     of money. She told us that we or our employees could set
want to get involved because of the person’s health                 up HSAs that would help cover the medical cost differ-
information and the HIPAA regulations. We are the                   ences. She not only brought over information on the dif-
middle person that speaks both languages.                           ferent insurance company bids, she also gave us
                            —Rebecca Swanson (OR)                   information on HSAs. Since then our firm has been going
                                                                    with a higher deductible plan and all our employees have
                                                                    HSAs. We feel we have not only saved our company
The Kidder Group, Inc. has used Angie and Lori for the past
                                                                    money, the HSAs have encouraged savings as well.
10 years. They have been instrumental in helping our small
                                                                                                      JANIE LOONTJER
business with both the initial sale of the insurance and the
annual renewal as one would expect as a broker. However,
both Angie and Lori go above and beyond for us as a small           Service, service, service...this is what a good agent or
business and work as intermediaries with the insurance com-         broker does for the client after the sale. Many times,
pany when needed. They have been able to help us clarify er-        as in our case, an agent has many small employers
rors on the side of the insurance company multiple times. In        (two-49) that do not have a HR director and thus uti-
essence, the big insurance companies are about as responsive        lize us in that role. We get many calls daily about a
as our government employees and usually just as unhelpful.          claim issue, billing issue, and now more frequently,
However, when we call Angie or Lori, I know the person on           “I can’t afford my current coverage. Is there anything
the end of the line and they know us. When necessary, they          else out there?” It is our practice to tell every employer
come and meet us in person. I have yet to meet a “person”           and employee when in a meeting to please call us to
from the insurance companies, and often those insurance             help them with the issue because more than likely
company employees are overseas. To sum it all up, our only          when they call the 800-number they are going to get
connection to the insurance company is our broker. They pro-        frustrated with the time it takes or the outcome of the
vide valuable service and advice. They actually earn their          call. We feel that it is much more important for them
commission by providing outstanding service.                        to feel that we care about what the problem is and
                                                                    that we will do our best to resolve the issue quickly.
If we want to save private health insurance, we need to
really reform the system and bring transparency back to             We as agents know these people firsthand and they
the relationship between the medical community and the              trust us and our judgment. They know that what we
patient. Fees for services should be posted both in the of-         are telling them is the truth and that they can count
fice and online. Doctors should know what the service               on us to be there when needed.
costs. And, most importantly, the services should all cost
the same, regardless of whether the patient has insur-              People that are in this industry have to have com-
ance or not and they should be the same within the in-              passion and a strong will because we certainly are
surance community.                                                  not getting rich in this line of work.
                                                 GARY T.                                           —Lori Dickerson (SC)


We own a small general contracting firm in San Antonio              In Re: Letter of Recommendation – Jerry Hardin,
and have been using Hairston, Johnson & Associates as               Pritchard & Jerden
our medical insurance broker for over 10 years. Every
year, Sandy Johnson sends over spreadsheets showing us              Dear Mr. Jett:
different insurance options we might want to look at to
help save our company money. Whenever we have ques-                 I have been asked to provide a letter of recommendation
tions we know that we can count on a quick response                 for the above stated individual. For the sake of


                                                               57
                     B R O K E R S          M A K I N G             A     D I F F E R E N C E



introduction, my name is Malcolm McCarn. I am the                       with employee handbook compliance, federal
CFO & General Counsel of CKS Packaging, Inc., a man-                    and state regulatory changes, 401(k) regulatory
ufacturer of plastic containers. CKS Packaging has 15                   changes, ARRA, etc. We are averaging about 40-
operating facilities spread throughout the South; we have               45 employers attending on a regular basis. We
more than sixteen hundred employees. Sales for 2008                     do not charge for this event.
should be approximately $285M.
                                                                  2. We build a customized benefits portal for our
We have been self-insured for 15 years and used another              clients at no charge to them that contains all in-
TPA for more than 10 years. I met Jerry in 2005 when he              surance plan specs, SPDs, HR Forms, wellness
came to offer me an alternative to my current TPA. Over              content and a page for PHR development. The
the course of several months we developed a friendly but             site provides timely newsletters with pertinent
professional business relationship. He made a proposal for           content.
our health insurance, and even though the bid was un-
successful, Jerry continued to make innovative suggestions        3. We provide no-fee access to our staff for HR and
that would reduce insurance costs for the company.                   wellness consulting with experienced profes-
                                                                     sionals in both categories.
In the spring of 2006, he suggested a pharmaceutical
program that would reduce costs by more than $100M to             4. We offer, on a voluntary basis and without
a program I thought was already pretty lean. His sug-                charge, a very basic form of financial wellness
gestions proved to be correct so we implemented them.                based on the training the Dave Ramsey brand
                                                                     enables us to offer as Endorsed Local Providers
Change is never easy, but when the right person comes                for his organization (ELPs). This education for
along that you think can enhance your operation, make                the employees and their spouses alike provides
your company more efficient and most importantly re-                 them the tools to get out of debt faster and
duce costs thus increasing profitability you must do the             teaches them how to spend their money more
right thing. I changed because Jerry seemed to be that               wisely.
person for CKS Packaging. He continues to service our
account today.                                                    5. We offer access to a specialized group of profes-
                                                                     sionals called the Employer Advisory Group
Jerry is a man of integrity, an astute insurance person              (EAG) to provide solutions in areas we cannot pro-
and the person I needed to assist me with the sometimes              vide for the employer such as P&C, Senior Prod-
difficult health insurance decisions facing employers                ucts, Business Banking, Labor and Employment
today. I recommend him without reservation.                          Law, 401(k), Business Continuity Planning, etc.
                              MALCOLM MCCARN                         This is a value-based group that voluntarily meets
                                                                     monthly to educate ourselves in order to offer
                                                                     value to our clients and the community alike – we
We have been encouraged by partnering entities to
                                                                     do not revenue share as it is strictly forbidden in
write you to discuss elements of our value proposi-
                                                                     order for the group to be purely value based.
tion that are making a difference for our employer
clients. We offer a myriad of HR-centric services that
                                                                  All of these value-added components are in addition
assist our clients from an educational and compli-
                                                                  to our role as employee benefits brokers. I hope this
ance perspective.
                                                                  narrative will be useful to you. Clearly, without these
                                                                  tools, our clients have commented often that they
1. Semi-monthly (nine out of 12 months), we de-
                                                                  would be without resource and probably in a lot of
   liver a seminar series called inFORUM in which
                                                                  compliance trouble.
   HR professionals and business owners alike at-
                                                                                                   —Colin Smoak (SC)
   tend to interact with speakers on a non-insur-
   ance products topical basis. Speakers engage

                                                             58
                                       G R O U P         M A R K E T



Our agency specializes in the small employer (two-               and others to access information
20 employees) market. Since the companies we                 •   Research financial viability of insurance com-
work with cannot afford to hire human resource per-              panies and consult individuals on credibil-
sonnel, we assist them with duties that may typically            ity/value of plan offerings
be done by human resource staff, thereby helping             •   Assist individuals with the completion of forms
small business owners control a portion of their                 requested by government and other entities
costs. In addition to the placement of insurance, we
perform the following services:                              In summary, we are the most accessible advocate
                                                             that employers and employees have in resolving is-
•   Negotiate renewal rates and identify items that          sues with the carrier or provider.
    should be considered by carriers when deter-                                        —Ronald E. Seibel (TX)
    mining renewal premiums, i.e. turnover of per-
    sonnel, addition of new hires, etc.
                                                             Last October, a client of ours (a new and used car
•   Provide an administrative booklet with neces-
                                                             dealer) was forced to shut down his business. He had
    sary forms, new legislation, information about
                                                             more than 100 employees in 17 locations but he could
    HSAs, premiums, plan designs, etc.
                                                             no longer operate—he was bankrupt because of the
•   Assist clients with claim issues and when nec-
                                                             economy. The owner was able to keep the health in-
    essary compile documentation to support claim
                                                             surance plan going for himself and his family, and also
    issues
                                                             so that all his former employees could access health in-
•   Assist clients with letters to providers (doctors
                                                             surance through the COBRA provisions until they
    and hospitals) to resolve claim issues
                                                             could find other coverage. Most employees went on to
•   Assist COBRA-eligible ex-employees with se-
                                                             find other employment and health plans, but at the
    lection of coverage
                                                             time of the ARRA stimulus subsidy law in February,
•   Assist employee family members with the se-
                                                             this group plan had five people left on it as COBRA
    lection of coverage when employer-based plans
                                                             beneficiaries along with the owner.
    are too expensive
•   Meet with employers/employees to explain ben-
                                                             Once the new subsidy provision became law, no in-
    efits, plan designs, and optional coverage
                                                             surance carrier was providing any information or in-
•   Assist the employer in selecting the appropriate
                                                             structions about a company’s responsibilities or even
    plan(s) that best meets the employer and em-
                                                             how the new program would be administered. Even
    ployee objectives and goals
                                                             though the provision was active on March 1, the IRS
•   Assist employers with billing issues
                                                             didn’t publish the model notices until March 19. I can
•   Inform insurance companies of employee adds,
                                                             tell you that all my client companies were confused.
    changes and terminations and request employee
    ID cards
                                                             Because this company that was no longer in business
•   Meet with insurance companies and provide
                                                             and its employees no longer making a payroll, the
    feedback of employer issues which assist carri-
                                                             owner began to ask me how he would possibly be able
    ers in making changes to plan designs, under-
                                                             to follow the subsidy’s requirements. He had five ex-
    writing procedures, etc.
                                                             employees now on COBRA, but over 100 lost their em-
•   Assist employers by providing a one-stop shop
                                                             ployment and their coverage last October. They had to
    to access information on multiple insurance
                                                             be notified and given the option to elect coverage, and
    companies and multiple products, i.e. health,
                                                             how should he do this? Because he turned 65 in April,
    life, dental, vision, retiree benefits, long-term
                                                             he chose to cancel the group plan at the end of March
    care, and disability insurance. The access to
                                                             and enroll in Medicare. He was scared of the potential
    multiple carriers allows the employer to select
                                                             liability that he might have if even a few of those 94
    the specific insurance company and plan that
                                                             people who did NOT elect COBRA decided to re-en-
    meets their needs
                                                             roll March 1 under the “special enrollment” privilege.
•   Provide a website for the employer, employee

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                   B R O K E R S         M A K I N G            A    D I F F E R E N C E



He no longer had a payroll from which to withhold            people for every one policy that we actually were
taxes and therefore “deduct” the subsidy money, and          able to place from this group, but we were glad to
he was afraid that he personally would be required to        help all of them. We are compensated by the busi-
pay the 65% for many former employees. Yes, he un-           ness we sell, and we didn’t sell much business at all
derstood that this money (the 65% of the COBRA pre-          during the last five months. We’re just lucky that we
mium) would be reimbursed to him eventually, but             were able to continue to be here to help our clients,
how do you pay something when you don’t have any             even if it meant helping them leave us.
money and can’t get a bank loan?
                                                             If the government decides to offer a universal health in-
My agency works with over 150 employer groups,               surance plan for all citizens, if there is any kind of choice
some small and subject to state continuation; and            involved, and particularly if there will be a choice be-
some larger plans, subject to COBRA. For the last            tween a private or a federal plan, health insurance
month, we have sent many e-mails to our clients and          agents will be the first person that all of my clients and
mailed many copies of the IRS model notices, the             even most of my personal friends (many of whom I
DOL instructions, and question/facts detailed by             have never sold anything to, but usually am asked for
both government agencies, as well as the COBRA               advice on their own employer’s plans) will call.
administration companies used by our clients, just
to keep them informed. It’s all very complicated, and           If the federal government decides that health in-
we field questions daily from our clients about this            surance agents are part of the administrative
subsidy. Who is eligible? Who do I notify? When do              cost of health insurance that is unnecessary, I
I notify them, and what do I say? How do I get re-              am quite positive that the government will need
imbursed? Why do I have to do this?                             to hire all of us agents as “experts” because all
                                                                my clients (and all the clients of all the health
ARRA is a government stimulus plan, COBRA is an                 insurance agents across the country who do the
employer law, but because these both relate to                  same work as I do) are going to be wanting
employer-sponsored health insurance, our clients view           someone to help advise them as to which plan
the people in my agency as the experts. Who in the              fits their budget and is the best for them. And I
government can you call for instruction? Who can di-            don’t think the federal government has enough
rect you to the place to find the answers? My clients           phone lines or enough employees to take all
call our agency. Precious little information has been           those calls.
sent to member clients by the insurance carriers. We                                  —Sarah Gunter Canez (TX)
are the front line person that the employer, the em-
ployee, the spouse of the employee and the HR direc-
                                                             Keeping a client happy requires providing extensive
tor calls for information and instructions.
                                                             support after the sale. If an agency does not provide
                                                             this support, they can be easily replaced by someone
For the last five months, for a defunct business that
                                                             who will.
is closing up shop, we have personally worked with
                                                                                          —Mark Thurmond (TX)
100 people who needed health insurance. For a few
of these people, we were able to find individual cov-
erage, and for a few people with health issues, we           About a year ago, I had lunch with an old friend
were able to help direct them to the Texas High Risk         who I only see twice a year—her birthday and mine.
Pool. Others had questions about continuation of             At the time—her birthday—I’d been working for the
coverage from the old plan to their new employers’           Utah Association of Health Underwriters for about
plans. Others wanted help with our local university          nine months. She and her husband are small busi-
plan, Carelink, for low-income people. Most just             ness owners. At my birthday lunch the previous Au-
wanted to find out what was the best coverage for            gust, when I’d been on the job only three weeks, I’d
them for the cheapest price. We assisted over 10             asked a little about their health insurance situation


                                                        60
                                        G R O U P          M A R K E T



but I didn’t know very much myself. She had told               pany’s billing cycle changed and the first bill for the
me that their broker always worked hard for them.              new plan came in a month later. The employer al-
                                                               ways pays by the due date. They thought they were
So, during last May’s lunch, I followed up with more           paying the current month when, in fact, they were
questions about the business and their coverage. She           paying a month in arrears because of the late bill.
said that although they offer coverage to their em-            They paid again the next month, but were then more
ployees, she and her family were by far the biggest            than 31 days in arrears and were cancelled. Their
users. I asked what kinds of rate increases they had           policy and coverage for all employees was cancelled
seen. She then launched into an excited discourse              by the insurance company and the company refused
about what an amazing job their broker had done                to reinstate without an exception from the billing
for them over the years and especially the past two            manager. I worked with the group to determine what
years. She said their carrier had twice wanted to              happened, helped them document the situation for
raise premiums by nearly 20% but that their broker             the insurance company and the exception was
had been able to talk them down to an astonishing              granted as a result of our advocacy. It is unlikely they
0% increase both times. I then asked who her bro-              could have navigated this to the top without our ad-
ker was, figuring there was a chance I might have              vocacy. The employer understands this and would
met them or at least heard the name in the past nine           never want to work directly with the insurance com-
months. When she said, “Gina...,” I immediately                pany red tape and management layers.
completed the name. “Dalton?” I asked. “Yes,” she
said, “you know her?” “You bet,” I responded, “She’s           Case Study #2
our legislative co-chair.”                                     Small-Group Employer – This employer of 50 em-
                                                               ployees has both a Virginia operation and a New Jer-
I then found out that in the twenty years they’d               sey operation (16 employees). The Virginia plan was
owned the business, they’d had two brokers: Gina               inadequate for the New Jersey employees. They had
Dalton and her business partner, Robin Telesco, our            no idea how to access New Jersey markets. We iden-
state association secretary for the past several years.        tified the markets, prepared the RFP and found
In the nearly two years that I’ve worked for UAHU              coverage that met the needs of all New Jersey em-
and with agents, I’ve met many amazing people;                 ployees. They went from being very dissatisfied to
men and women whose main mission is to get their               very happy with their new plan. Employees’ benefits
clients the best coverage at the lowest cost and to            increased significantly. We found coverage for all
support those clients with top-of-the-line after the           and made sure no one lost coverage or had to navi-
sale service.                                                  gate the complications of changing carriers and pre-
                                                               existing condition limitations of insurance carriers.
Let’s hear it for great brokers!
                              — Martine Smith (UT)             Case Study #3
                                                               A husband and wife with individual policies re-
                                                               ceived a large increase from their carrier even
Case Study #1
                                                               though they had filed very few claims. They could
Small-Group Employer – The employer received a
                                                               no longer afford to pay upwards of $1000/month for
large renewal increase to their employee benefit plan.
                                                               their insurance. We worked closely with them and
We provided optional plans and carriers. In the end,
                                                               educated them on the health savings account con-
they stayed with the same insurance company but
                                                               cept. They changed to two new policies and reduced
reduced benefits somewhat to make the plan afford-
                                                               their premium cost by more than 50%.
able so that they could continue to pay 100% of the
                                                                                        —Sidne S. Dickenson (VA)
employee’s coverage. Without our help, this process
would have taken twice as long and they could have
made a serious error, since they are not insurance ex-
perts. As a result of the change, the insurance com-

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                     B R O K E R S          M A K I N G              A    D I F F E R E N C E



Steve,                                                            Rick Rosaaen. Rick was one of the first people I met. He is
                                                                  friendly, easy to talk to, accommodating and very intelli-
I wanted to take a minute to express my thanks and ap-            gent. I appreciated Rick’s willingness to come into a meet-
preciation for all Albers has done for me and BCRA in             ing with little or no notice. He listened to our concerns and
the past three months.                                            tried to find the best answer possible to all our questions. I
                                                                  really enjoy Rick’s personality and ease with which he deals
As you know, in October, I came to BCRA in the position           with people. I know he does a lot of work behind the scenes
of benefits administrator. I came into the company after          and I know we benefit from his hard work and I’m no less
taking several years off to raise a family. I came in at a        grateful for all his work on our behalf.
time when the company was preparing for an open en-
rollment period. It was also a time when businesses were          Kristin Verone. I have never met Kristin but I know she has
facing their own economic challenges. This combination            met with many of our employees individually. She has been
could have created many hurdles for us as we began the            a great resource for our employees seeking assistance with
process of re-negotiating our contracts. After our intro-         individual plans and Medicare. Each employee who has
duction in October you and your team began the process            had the opportunity to meet with her has come back with
of researching plans and premiums that would best meet            good reports. Each of them had complimented her and
the medical needs of our employees and financial needs            commented on the benefit she was to them.
of our company. I know this was challenging as the pre-
mium rate increase was substantial. But with your hon-            Brent Price. Recently we have had the pleasure of meeting
est and expert recommendation, we were able to narrow             with Brent regarding an inquiry and interest in long-term
down the multitude of choices you presented to a dual             care. Brent was given a short lead time to present some op-
option for our employees. This was an arduous task as             tions for us to consider. He was flexible, informative, and
we required many layers of communication, sometimes               professional. He presented his findings as well as his rec-
repetitive but always needing flexibility. Your team was          ommendations with noticeable expertise. I have appreci-
always responsive to whatever our need or requests were           ated working with Brent on our latest research efforts.
in order to facilitate a decision.
                                                                  Patty Rice. Patty, like Rick, was one of the first faces we
Once the decision was made, Albers was always avail-              saw. From the beginning she has been there holding our
able to help walk us through the transition. As we were           hands through the last three-plus months. I have Patty’s
changing plans and renewing contracts you were work-              phone number on speed dial and don’t hesitate to use it!
ing behind the scenes to make sure all the paperwork was          She is extremely knowledgeable, accommodating, un-
completed accurately and on time. You handled the open            derstanding, and helpful. I know there are many days
enrollment employee meetings very professionally and              she has worked late and on weekends on our behalf. She
we have enjoyed the use and ease of the Employee Ben-             has interfaced for us on all levels of the open enrollment
efit Center ever since. The administrative work after the         process with the carrier and our employees. She has gone
open enrollment has presented its own set of challenges.          to bat for us during negotiations and flexed her muscles
There has been less than accurate or sufficient commu-            during the frustrating transfer of plans. Patty is a pleas-
nication with the carriers. There has been no way I could         ure to work with and I feel she has our confidence. I trust
have handled the transition without the help of Albers.           her to handle any concern I may have in administering
                                                                  benefits within BCRA. I know that if she can’t handle it,
I am so grateful for the service we have received from            she will find someone who can. I really appreciate the
Albers and Company that I wanted to let you know the              relationship that has developed between us.
extent of my appreciation. I would like to name a few
people that have really stepped up and successfully con-          In closing, I just want to reiterate my appreciation to Al-
tributed to the administration of our benefits.                   bers and Company and the services you have provided
                                                                  BCRA and myself in the last three months.
                                                                                                             JENI ENSLIN


                                                             62
                                               G R O U P            M A R K E T



Texas RV Supply has had the assistance of Hairston,                     I met with an employer in Spokane, WA last week
Johnson and Associates in acquiring top-quality health                  and conducted an employee meeting to share ways
insurance for the last 15 years. Each year, Sandy John-                 to save money in the use of health care services and
son and her associates shop the industry and offer dif-                 go over the benefit design of this group’s current
ferent options that make it affordable for our small                    group medical insurance plan. This is a service that
business to offer our employees excellent health insur-                 our firm provides on a regular basis for all of our
ance. At renewal time each year, Sandy or an associate                  750 employer-employee group clients.
will come to our business and thoroughly explain to each
of our eligible employees what each plan entails, de-                   After the meeting, four employees approached me
ductibles, out of pocket expenses, drug plans, and an-                  with concerns about finding a primary care physi-
swer any questions they may have. Then, throughout the                  cian who would be willing to take them as new pa-
year, if I have any questions concerning eligibility, em-               tients. One of them had experienced a stroke a year
ployee claims questions, etc., I will call Hairston, John-              or so ago and hadn’t been able to get any assistance
son and Associates for assistance. The staff is always                  from his specialists to locate a primary care physi-
professional, very helpful, and provides outstanding serv-              cian that would take his case. Our firm contacted
ice within a timely manner. I feel like I am their only                 our local medical society and was able to locate a
client because I receive answers so quickly by phone or                 medical practice that would take these employees
email. I don’t ever feel like I am left to figure out all of the        on as new patients.
ever changing laws about health care issues, state con-
tinuation, etc. I receive relevant information from Hair-               This is just one of many consumer advocacy roles
ston Johnson regarding upcoming changes in legislation                  that we play for our clients.
that will affect our business, i.e. the COBRA subsidy ad-                                            —Mark Newbold (WA)
ministration and State Continuation updates affected the
American Recovery and Reinvestment Act.
                                                                        We are a very small agency (six licensed agents) and
                                                                        most of our clients are small businesses as well
I would also like to tell you how Hairston, Johnson person-
                                                                        (under 50 employees and many under 10 employ-
ally assisted me with health care claims and physical ther-
                                                                        ees). Small businesses make up the bulk of Eastern
apy claims a few years ago. In 2005, I had shoulder surgery,
                                                                        Washington business and are essential to the sur-
which required extensive physical therapy. My health care
                                                                        vival of our small cities. As brokers, we shop for
provider at the time limited my physical therapy sessions
                                                                        workable benefit options and help small business
and refused to approve additional sessions. Marlen Man-
                                                                        owners with HR responsibilities as many of them are
cias, an associate at Hairston Johnson, personally called my
                                                                        too small to employ HR people. We conduct em-
health care provider about my case and was able to suc-
                                                                        ployee meetings to explain benefits and help with
cessfully explain that the standard physical therapy sessions
                                                                        completion of enrollments.
normally approved and paid for by the provider were not
enough for my recovery. This was after the doctor and phys-
                                                                        The most important benefit we bring to the small
ical therapist sent letters to the provider requesting addi-
                                                                        business owner, however, is knowledge. We work
tional sessions that were denied. If it were not for Marlen
                                                                        hard to educate ourselves on the ever-changing
getting very involved with my claims, I would definitely have
                                                                        landscape of employee benefits so we can pass this
physical range of motion limitations with my shoulder and
                                                                        knowledge on to our employer groups. The most re-
substantial physical therapy bills not covered by my
                                                                        cent example is how the ARRA affects COBRA
provider. In closing, our broker Hairston, Johnson and As-
                                                                        rights. Small business owners are busy managing
sociates have always treated us with care throughout the
                                                                        their companies and don’t have the time or the re-
years. Helping us renew our insurance benefits is such a
                                                                        sources to keep up on all the government regula-
small part of what Sandy and her associates do for us the
                                                                        tions that keep being added to the already
rest of the year. Thank you for listening.
                                                                        over-abundance of required compliance items.
                                           PAM SKINNER


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                     B R O K E R S          M A K I N G              A    D I F F E R E N C E



I know there are a few bad agents that give the rest              Another service we provide is mailings to our clients
of us a black eye, but the majority of us work hard to            on issues that impact their benefits. An example of
help businesses help themselves and their employ-                 that is in regard to the COBRA subsidy rules. I’ve
ees. The measly one percent to 10% commission we                  sent my clients information on the subsidy rules,
make for all the hours involved, particularly behind              forms, etc., and encourage them to contact me with
the scenes, pales in comparison to what it would cost             any questions so I can help walk them through this
the government to provide the same services. All we               process. I’ve also attended several meetings on the
have to do is look at the mess Medicare is in and par-            COBRA subsidy to obtain current information.
ticularly the underestimation of Plan D costs to see
that government control is not the answer. So much                I have also worked with the provider community to
of the time, what looks good on paper does not work               provide education for my clients on wellness. One of
in the real world. Sadly, the majority of our elected             our providers will do health assessments for a small
leaders have forgotten what it is like to live in the real        fee based on level of participation. Based on the re-
world so it’s no wonder they sign onto something                  sults of the assessment, we then tailor our wellness
without thinking it through.                                      presentations to topics that impact the majority of
                               —Deborah Kay (WA)                  the employees.

                                                                  We take our client relationships very seriously and
There are numerous ways in which our agency as-
                                                                  pride ourselves on doing what is best for each
sists clients beyond the initial sale. Here are a few
                                                                  client’s individual needs.
examples:
                                                                                             —Kate Ludwigson (WI)
Individual clients—when they contact us with any
questions or concerns about their policy, such as                 I am writing to share real-life stories about the im-
provider network changes, benefit changes or claim                portance of the role of agent and brokers in helping
questions, our agency handles the inquiry. We work                consumers obtain much needed health insurance.
with the insured, the carrier and the provider (if
needed) to resolve the question. Also, when I receive             The most important point specific to our role that
a renewal on an individual client I check with the                Congress needs to understand is that we are the con-
other carriers I work with to see if we might be able             sumer’s advocate.
to match benefits at a lesser cost to the insured. Each
year I contact them to discuss their options.                     I would like to take a moment to tell you how valuable
                                                                  one of your agents has been to our company. Donna Mc-
Employer clients—prior to each group renewal I re-                Cright is such an asset to us. She is very knowledgeable,
quest basic census information and go to the market               courteous and helpful. I cannot put into words the grat-
to get base quotes. By the time I receive the renewal,            itude that I and the rest of our employees have for her.
I have enough information for the client to make an               She has, in my opinion, gone way beyond the duties of
informed decision on whether or not to go to the                  just an insurance agent. She has provided us with tools
next step of applications. If a client goes to applica-           and education that have been key to our company and its
tion, our agency assists with every step of the                   compliance with insurance laws and has helped me on
process to ensure accuracy and privacy of informa-                several occasions with our insurance plans and various
tion required. I then meet with the client once the               questions from myself and my employees.
final rates are determined to discuss the pros/cons
of each carrier. We also hold employee meetings to                One instance in particular that I would like to comment
discuss the benefits, how to manage their out of                  on relates to our carrier not wanting to budge on a pre-
pocket costs, etc.                                                existing situation for one of my enrollees. Donna did not
                                                                  waiver in her stance to get this issue resolved and I truly
                                                                  feel she saved a life with her efforts.

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                                            G R O U P           M A R K E T



Thank you so much for allowing Donna to be our insur-               needs. I just returned from a small business client
ance representative as we could not be where we are                 who needed my help setting up multiple plans. My
today without her. I feel that if such an award existed, she        client’s workforce became more diverse and thus we
would deserve to be Citizen of the Century.                         wanted to offer more than one health plan and let
                                          RUTH QUAN                 the employees choose the plan that best fit their
                                                                    needs. In this case, we offered three plans, a $500,
                                                                    $1500 and a $2000 deductible HSA plan.
Without the help of brokers, small business would be
lost in regards to group health insurance, employee
                                                                    We are ongoing consultants for our clients who
benefits and related legislation. A prime example is the
                                                                    would otherwise be clueless simply because they
ARRA COBRA legislation that was recently passed. I
                                                                    have no time to spare to learn the ins and outs of
have spent all week explaining to my clients how to
                                                                    the health insurance industry. They have all their
comply and how to get reimbursed the subsidy
                                                                    focus on keeping their people employed. I work
through their 941 payroll forms. I have set up many of
                                                                    with basically every health insurance company and
my clients through administrators of this service and
                                                                    HMO contracted to do business in my state. It
many at no cost through offerings by insurance com-
                                                                    would be impossible for business owners to know
panies. These free administrative services would go un-
                                                                    every coverage difference between them unless you
noticed if we were not there to recommend them to
                                                                    did this for a living. For example, I have a client
out clients. Most small business wouldn’t even know
                                                                    whose child was born without a lower right leg.
about state continuation of COBRA if we were not
                                                                    There are only a couple insurance companies in my
there to tell them about it, much less explain it to them
                                                                    state that do not limit coverage on prosthetics. Most
and administer much of it for them.
                                                                    limits on durable medical equipment and prosthet-
                                                                    ics range from $2500 to $5000 coverage per year per
Many small businesses have no human resources
                                                                    person. My client’s son’s costs were $25,000. That
personnel. We are their HR back office. I deal with
                                                                    would be money he would have lost if we were not
new employees and also work with those who are
                                                                    there to fit him with the right insurance company.
leaving by setting them up on state continuation or
COBRA or find less expensive options with individ-
                                                                    I could write for hours on everything I do, but most
ual plans to make things more affordable. Our rela-
                                                                    of my time is spent servicing my existing clients (free
tionships with our clients are ongoing since they
                                                                    of charge) and very little is spent searching for new
have no time to deal with everything we do. All my
                                                                    ones. I’ve been a broker for 15 years and prior to
clients’ employees are given my business card and
                                                                    that I was a group health underwriter for 6 years.
they call me with questions or issues with things
                                                                    The payer system is not broken in the private sector;
such as healthcare claims, provider questions, cov-
                                                                    in fact, it is alive and well thanks to competition.
erage questions or any other issues that arise. After
                                                                    The healthcare delivery system is broken, along with
I have written a new policy for a new client, the
                                                                    Medicare, Medicaid and the state-run programs.
work now begins—not ends.
                                                                                                 —Robert Jandrain (WI)
Brokers are the gatekeepers to the health insurance
world. We know which carriers are good and we                       I am an insurance agent specializing in the small-group
know which are right fit for the needs of our clients.              market. On a daily basis, we help our clients wade
It is with the broker that competition is at its best. If           through the process of deciding which insurance plans
insurance companies don’t make our grade, they                      will suit their budget and employee needs. We apprise
don’t get sold. If their rates are too high or their cov-           them of the variety of products available and how these
erage is lacking, I let them know. PPO, POS, HMO,                   plans, such as health reimbursement arrangements and
HSA, HRA, and FSA are just a few acronyms our                       health savings accounts, may be better options than
clients wouldn’t understand without our help. We                    their current traditional plan with deductibles and co-
have to continually analyze our client’s changing                   pays. Many employers don’t really understand the

                                                               65
                     B R O K E R S         M A K I N G          A   D I F F E R E N C E



nuances between all these plans and how they may
help or harm them. We discuss the pros and cons be-
tween having a group plan and not.

I have helped a number of clients resolve complicated
claims issues. Without my assistance, they most likely
would have just given up and paid significantly more
in claims than they were obligated to pay. While in-
surance carriers strive to pay claims correctly, many
times, I find it is the provider who made the error. The
insurance carrier is merely paying based on what they
receive. Without the experienced agent reviewing this
information, it may go unnoticed.

The recent COBRA subsidy is just the newest issue to
review with clients. Many have looked to me for guid-
ance and explanation of what their responsibilities are.
Even though this is an employer compliance law, many
employers don’t truly know what they are supposed to
do. The smaller the group becomes, the more likely it
is they may overlook this important aspect and put
themselves and their company in serious trouble.

I hope this helps explain in an abbreviated way, how
important the insurance broker is in the process of
selling group and individual insurance. My clients
turn to me for guidance, problem solving and sup-
port. Many have told me how much they value my
service and would be lost without it. For the small
business owner, I am their human resource depart-
ment in regards to the insurance benefits.
                                —Laura Bagin (WI)




                                                           66
                              Medicare Market
I have been a Medicare sales representative for 15 years.           Alabama Medicaid Agency application for her,
During that time, I have developed an excellent dis-                which was approved and eliminated the
course with numerous community centers of influence.                $96.40 premium which raised her income
I have been an avid proponent of doing the job right.               drastically. I enrolled her into a no premium
Even the Area Agency on Aging discusses issues with                 SNP plan with no deductibles or co-pays. Now
me and a handful of agents who have mastered                        she even has a ride to go to the doctor’s of-
Medicare and educated the area of Mobile on not only                fice—before I met with her, she didn’t even
our plan benefits, but also Medicare itself. Many times,            have a doctor. She had not seen a doctor in 15
I have left clients with total confidence that they now             years because she couldn’t afford one due to
were clear on how Medicare is administered, including               deductibles and coinsurance. She now gets
reimbursement rates, demographics, etc. Until plans                 medication for $0-$3 on each prescription,
came along, the federal government did and still does               annual physicals, vision, and pays $0 for all
send out a book for people coming under Medicare.                   health care. She actually broke down crying
This book, even after the untrained person reviews, is              about someone caring for her.
totally confusing to beneficiaries. I don’t simply enroll
people, I educate them. I even go as far as to get all              I don’t know about you, but that is what I do:
other help for clients, something the federal govern-               help people. The government doesn’t contact
ment obviously spends little time doing.                            you—if you need special help, you must con-
                                                                    tact the government. We do an excellent job
An example of this:                                                 going the extra mile for our clients. How else
                                                                    will people, many uneducated, know what is
   One day I went to Irvington to an appointment.                   available if we don’t contact them?
   I had difficulty locating the beneficiary’s res-
   idence until I noticed a house in the middle of               I, in fact, turn in the wrongdoers as I come across
   a field. I was training another agent that day                them. The wrongdoers are the problem, not the
   and told him to drive down a pig trail into the               agents who do right.
   field, thinking maybe she lived there. As we
   neared the house, which was totally dilapi-                   The above story is true, but I come across this every
   dated, I noticed tracks going around the                      day on my job. To eliminate the agents like myself who
   house. It led us to a trailer, also in total disre-           go into the highways and byways helping these people
   pair. An elderly lady of about 80 years old lived             will hurt them to no end. Please make this a priority.
   alone in the trailer.                                                                          —John Walley (AL)

   Upon questioning her, it became clear she was
                                                                 Our company works in three markets: employer
   destitute and needed help. It was revealed her
                                                                 groups, individuals (sole proprietors/independent
   total income was under $400 per month, and
                                                                 contractors) and Medicare-eligible.
   still the government took out the Part B pre-
   mium of $96.40. We were in complete disbe-
                                                                 Our consulting provides these clients expertise in
   lief. I asked her if the trailer belonged to her.
                                                                 reviewing their options with recommendations for
   She said no, that her friend died and her
                                                                 plan designs that fit their coverage needs as well as
   friends’ children didn’t have the heart to make
                                                                 budget. We also provide day-to-day service for all
   her leave. She stayed there for free, but almost
                                                                 clients, including the employees of the employer
   starved to death and had no heat or air con-
                                                                 groups. This frees the employer from having to be in
   ditioning. I took it upon myself to fill out an

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the insurance business and concentrating on run-                 intelligent people at insurance companies, physician’s
ning their business.                                             offices, and the state/federal government gives me the
                                                                 ability to quickly and effectively solve client problems
Our Medicare eligibles are especially important to               with better long-term satisfaction for all. Trust and
help decide the best supplemental coverage for their             professional respect are the qualities that make these
federal Medicare benefits. Any federal program en-               relationships work and allow creativity and common
acted will have holes and coverage deficits and our              sense to reign over stifling bureaucracy and unbend-
role as consultants does not diminish—if anything it             ing regulation. Without these relationships, my clients
is even more imperative they have a resource to help             and I would feel much more like numbers dealing
them review options and help with day to day issues.             with other numbers in these big organizations. Con-
                                                                 sumers need objective, personal liaisons that have
There is no perfect carrier (including Medicare!) or             their interests at heart and, most importantly, can
system and our role is vital to maintaining peace of             make the health care process a little easier for them.
mind and security for our clients.                                                                  —Rick Bruner (CA)
                              —Dianne Kelley (AZ)
                                                                 My office spends no less than 20% of our time edu-
I am a health/life broker specializing in individual/            cating people on their Medicare benefits. Cover Col-
group health insurance, life insurance and Medicare              orado (the Colorado option for the uninsurable)
Advantage/Supplement plans. As an independent,                   options, Child Health Care Plus eligibility, and op-
non-salaried broker, I am free to recommend the                  tions for which we as agents receive no compensa-
products of any company I choose. I am very com-                 tion for our work. This is a service we
fortable in this role as I much prefer teaching/con-             wholeheartedly and willingly provide because these
sulting to “selling” one product or company. This                people need assistance in understanding the health
business model also creates the incentive to build               care system and what all of their options are.
honest, long-term relationships with clients, as they
effectively pay my bills. I am in the trenches every             Within the past two days alone, we have assisted
day trying to find my clients the best possible health           four people in appling with CoverColorado, taking
insurance options – be they private or public.                   a COBRA option with another broker, and appling
                                                                 for a Medicare Part D plan, none of which we re-
The American health care system truly needs com-                 ceive payment for. We, as brokers and agents, are
petent brokers in the field. We are vital middlemen              constantly striving to educate ourselves with
who play many essential roles in our interactions                Medicare and other systems that don’t compensate
with consumers, underwriters, doctor’s offices, etc.             us. The people we help are most appreciative and
But our primary role, or “talent,” if you will, is the           have referred other people to us, which is a plus for
ability to communicate complicated information in                our “business” side. They have said that we have
a manner consumers can understand. There is an                   given them more information in a couple of hours
absolute necessity for a qualified field rep who can             than their employers, Medicare or Social Security
help the public wade through the complex morass                  has given them in numerous attempts.
of information, regulations, and bureaucracy that
epitomizes both private insurance and government                 There are always self-serving individuals in every
Medicare.                                                        market, but I know the agents who belong to organ-
                                                                 izations such as the National Association of Health
I am a vital link in the health care system. I am the oil        Underwriters are some of the most dedicated, hard
that makes the machine run. I have strong general                working and ethical people. I am one of them!
knowledge of all its parts and thus can create more                                          —Robin Mitchell (CO)
open, efficient communication between them. The
relationships I have formed with knowledgeable,

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I know most brokers go above and beyond to help                 works best for them. These appointments can some-
their clients—many times with things that they receive          times take an hour and a half or more. We do a lot of
no compensation for. How many of us assist people               business in the Medicare market. The meetings with
who are not even our clients with accessing informa-            senior citizens can sometimes take twice as long, par-
tion on and actually enrolling in plans such as Part D          ticularly when trying to explain their options for a
                  ,
Medicare, CHIP High Risk Pool and HIPAA plans? I                Part D prescription drug plan. We run their list of
know I have done a good bit of this in the past few             drugs through the various formularies so we can de-
years, and I am sure many others have as well. It is            termine which plan will be the most cost-effective for
very difficult for the average person to get information        them. For this (the prescription drug component), we
they can understand and even know where to get that             make $6.00 per month. That’s right—$6.00! I can’t
information on most of these programs. Also, many               think of one government agency that would offer that
people don’t even know these plans exist, unless we             type of service for such a small amount of money. We
tell them about them. I try to help anyone I can, even          even make house calls for our elderly clients who
though I am not compensated or get a modest enroll-             can’t make it to the office.
ment fee. The Part D program, in particular, is ex-
tremely complicated. I have helped many navigate this           We handle all of the claims after the sale as well,
maze and try to select the best plan for them out of            troubleshoot on behalf of our clients if any billing
40+ offered in my state of Louisiana. Most seniors do           errors are made, and assist our clients in the appeals
not use the internet and do not have anyone to help             process if that becomes necessary. Our clients truly
them with this important decision. I don’t think most           appreciate the service and are constantly sending us
members of Congress realize the services we provide             thank you notes, bringing us cookies and other
to our clients, and to many others who would be lost            goodies and most importantly, referring their friends
and probably end up with a plan that is not in their            and relatives to us because they know we will give
best interests, or no plan at all. We DO provide many           them the same excellent service regardless of how
valuable services that people cannot get by calling a           much or how little money we will make on the
toll free number and trying to get understandable in-           product we are selling!
formation and real help. We could be a valuable con-                                      —Rebecca Swanson (OR)
duit for any alternative plan that comes out of
healthcare reform legislation.
                                                                Every day, someone calls me to ask a question or ex-
                                                                plain the choices and options related to Medicare
Who would be better to explain and assist people
                                                                Enrollment, Medicare Advantage, Supplement, and
with their many choices? If we did receive some
                                                                Rx plans. Many have spoken to representatives at
compensation in return, it would be less expensive
                                                                the Social Security office and have received tons of
and would really reach those who need the help (on
                                                                forms, enrollment brochures, advertising material
a personal and professional level) than expanding
                                                                etc., which has only confused them further.
government bureaucracy. I am hopeful that the real
value of what we provide, as brokers, will be ac-
                                                                The following is an e-mail copied to me that a client
knowledged and put to work for all of our citizens!
                                                                sent to Aetna.
                           —Lyle D. LeLeux (LA)
                                                                   I am writing to tell you how much Joe Bailey
I am an independent insurance broker and have spe-                 helped me with the maze of Medicare plans
cialized in health insurance products for 23 years. I              available to a senior citizen. I was totally
employ three other individuals, two of whom are also               overwhelmed with the amount of material to
licensed. We don’t sell insurance over the Internet                be read and absorbed. It was such a relief to
…we sit down face-to-face with each of our clients,                have Joe explain in a simple way the different
explain their choices to them and let them select what             options, and to help me decide on the very



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                    B R O K E R S         M A K I N G           A    D I F F E R E N C E



   best coverage for me. I chose Aetna over the              I am an independent insurance agent in Lancaster,
   other plans for several items mentioned to                PA. I am licensed with many of the insurance com-
   me that were uppermost in my mind for my                  panies that provide Medicare Advantage plans in the
   particular circumstances. Joe met me at our               areas that I work. The reason for the different com-
   library (my choice for a meeting place) for me            panies is to be able to compare plans with the indi-
   to sign my papers, and Joe also told me to                vidual needs of my clients. I also sell Medicare
   call him anytime I had a question regarding               supplements. When comparing how the different
   Aetna’s plan. I did call him several times with           plans work, most of my clients would rather go with
   questions and he was always very friendly,                a Medicare Advantage plan because it often saves
   courteous, knowledgeable, and answered all                them money. Many of my clients save hundreds and
   my questions in a timely manner.                          some even save thousands when they switch to a
                                            ROBIN H.         Medicare Advantage plan from a Medicare supple-
                                                             ment. Medicare Advantage plans are more time-con-
                                   —Joe Bailey (PA)
                                                             suming to sell because you want to do what is best
                                                             for your client and find a plan that suits your client’s
   I had a couple of clients who were stuck in a             specific needs. You individualize each person and
   Medicare Supplement plan (at least they                   find the plan that works for them.
   thought they were stuck!) and paying $5,000
   a year for their Medigap plans through one                Although this is much more work, the rewards are
   carrier. I was able to help them out with a               greater for my client. When your client realizes you
   Medicare Advantage Plan offered by a differ-              are doing something that is specifically for them,
   ent carrier with a premium of $39/month per               they trust you. Trust from a senior citizen is some-
   person totaling $936 a year. Their total in doc-          thing you earn. They know I helped them get better
   tor and procedure co-pays and prescription                health care and saved them money. The satisfaction
   drug co-pays were another $500, giving them               of helping one better themselves is a reward in it-
   a total savings of $3,564/year. They were ec-             self. Even this year when I did not know how much
   static! This gave them the money they                     I would be getting for a commission, I felt I want to
   needed to pay back property taxes and keep                do what is best for my clients. I took the extra time
   their home. Medicare Advantage plans save                 to compare plans to needs. The Medicare advantage
   seniors so much. A few extra dollars can re-              plans are great plans. I have my parents on Medicare
   ally make a difference when it comes to                   Advantage plans and of course I want what is best
   keeping or losing your home.                              for them. They are 88 and 86 years old and the
                                                             Medicare Advantage plan has saved them thou-
On average, a Medicare Certified Broker saves a mar-         sands, which they would have spent on Medicare
ried couple at least $1,000 a year, much more in             supplements. I have many stories of how my clients
most cases, and when seniors are living on fixed in-         wanted to thank me by putting them on Medicare
come, every penny helps! I had a lady who was                Advantage plans, from baking a pie, giving referrals,
going for broke and paying AARP $150/month. I                asking me to go out to dinner but the best is the
was able to help her get on Medical Assistance (plus         hugs; I love the hugs. This part of my insurance
food stamps, then housing allowance) and put her             business made me feel like I actually did something
on a SNP Medicare Advantage Plan with Aetna and              to help someone, and that is what it is all about.
she’s always calling to tell me “you do one hell of a                                         —Joann Kline (PA)
job.” Most of the seniors don’t understand things
and instead of calling “Member Services” on their
                                                             Cindy and I want to thank you again...they found cancer
health plan they always contact their broker instead,
                                                             in her left kidney and she had it removed. She’s doing fine
who is always there for them.
                                                             now and she stopped smoking for sure—no other therapy
                              —Daniel Heskett (PA)
                                                             is needed except regular scopes. If we hadn’t switched to

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                                      M E D I C A R E              M A R K E T



the Texas Health Risk pool, as you suggested, our future         reached the gap. He had tried calling the carrier’s cus-
could have been radically different. Who knows when              tomer dept himself and gotten nowhere, because hourly
the next hammer will fall but thanks to you, we are ready        CSR staff members aren’t licensed agents—they are call
for it.                                                          center workers who are working their nine to five.

I was referred to this couple. They had a current lim-           I initiated a conference call to the claims dept with
ited benefit hospital-medical-surgery policy from a              my client on the line giving permission for me to be
major carrier that they were paying a $900-a month               able to speak to them, and by explaining the situa-
premium. The agent did not return any of their calls.            tion to the rep in a way my client could not, we were
First, I had them sign an agent-of-record so I could             able to quickly track down the problem: the carrier
service the policy. The carrier would not change the             had failed to initially charge the $295 deductible
agent-of-record for 12 months or allow me to serv-               back in January, and so now they were catching up
ice it until the policy was 12 months old. When the              and charging it in March. So this is why my client’s
policy was 12 months old, I requested a specimen                 statements showed co-pays at first, then full price
policy so I could see their benefits. It had several rid-        drugs, then co-pays again.
ers which might have excluded the above-men-
tioned condition. It limited prescription drugs to               The client was so grateful just to have simple un-
$2000 per person per calendar year. It had a                     derstanding. To say that these people could call car-
$25,000 maximum benefit for outpatient services                  riers and get straight answers without the kind of
per person per calendar year. It paid 50% after a                training that an agent has is ridiculous.
$3000 deductible.
                                                                 Keep in mind that CMS slashed my commissions this
They could not medically qualify for another indi-               year to $20 PER YEAR on this product, making it not
vidual policy and they did not have group insurance              even worth the cost of mailing out the initial packets and
available to them. I recommended that they change                assisting in running Medicare.gov searches for elderly
to the Texas Health Risk Pool in order to have more              people who sometimes are not computer literate. What
comprehensive benefits without riders or the limits              I earn is not even worth my time. But because we care
discussed above. I went to their home and spent                  about our clients, we do this kind of stuff all the time.
three hours completing the forms for each of them.
The husband wanted to mail the forms himself.                    So for any lawmaker who feels my role is unimpor-
                                                                 tant, have them give me a call. I can give them a list
Their e-mail makes me proud to be a insurance agent.             of clients and phone numbers who would gladly tell
                                —Edna Kern (TX)                  them how much I’ve helped them—above and be-
                                                                 yond what is required.
                                                                                            —Danielle Kunkle (TX)
This week I spent more than an hour on the phone
helping one of my Part D clients who is a Power of
Attorney for his elderly mother. They saw a disturb-             Please keep the government out of my decision making. I
ing jump in co-pay costs between their February                  would rather trust my agent, who I can fire any time I
pharmacy statement and March pharmacy statement.                 want, than to put my trust in the government who I can
After having called his pharmacy, my client said the             never get rid of. This socialistic attitude floating around the
pharmacist told him that they didn’t understand it—              nation now is not the way to personal freedom.
the co-pays just all of a sudden went up.                                                                         JIM CHASE

I suspected the coverage gap, but my client forwarded
me an EOB showing that his mother had not yet




                                                            71
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