Agent Vs. Broker ? Who do You Buy Health Insurance From By Medimanage.com

Health Insurance

Health care for all protest outside health insurance conference at Moscone West

guaranteedhealthcare.org

Info about the conference they protested which included speeches form for Republican Senate leader Bill First & for HHS Secretary (and failed presidential candidate) Tommy Thompson

www.ahip.org/links/institute2008/

Agent Vs. Broker ? Who do You Buy Health Insurance From By Medimanage.com

You are pretty clear that it is necessary for you to buy a health insurance policy. You know that considering the increasing hospital expenses and unpredictable mishaps that can happen, you need to have a health cover. You are even aware that you can purchase a health insurance policy from an agent or a broker. But you are confused as to which one you need to approach. First let us explain what the difference between the two is.

Agent – An agent is an individual who represents a particular health insurance company and is generally well aware of the different polices and packages that the company has to offer.Broker – A broker is a firm that has many health insurance companies’ policies to offer to you. The broker represents you and not any particular insurance company, and therefore compares differenthealth insurancecompany policies for you and helps choose the best one according to your requirement.

Now we give you a comparison, on basic grounds, between a broker and an agent, with reference to what they can offer you and what are their handicaps.

Individual/Personal attention

Agent – An agent is by and large an individual, catering to a limited number of clients, all within his immediate and personal reach. Therefore, when you deal with an agent you will receive highly individualistic and personalized attention.

Broker – Brokers are generally organizations; therefore, while they may score on professionalism, you will probably miss the individualistic and personalized attention an agent can give you.

Loyalty

Agent – An agent represents only one particular health insurance company therefore his primary concern is with that company and the number of policies that he sells. Your interest and need is not primary to him.

Broker - For a brokerhis primary interest is with the consumer and his needs. He represents the consumer not any health insurance company.Brokers are not concerned with any particular health insurance company as he gets paid by them all so when recommending a product, they will only have your interests in mind. They offer you a platform for thorough comparison and then help you to decide.

Knowledge and experience

Agent – To become an agent an individual has to pass an exam and though that personally gives him a fair knowledge about insurance and subsequent in-house trainings provide knowledge of his company’s health insurance policies, he does not have knowledge of other health insurance company policies.

Broker – Since a broker sells policies of all companies, he has knowledge of them all giving you a wider spectrum of choice and details. Also to become a broker the organization needs to obtain a license which is not easy and involves a lot of stringent criteria that in the process gives the broker more insights than an agent. A broker, unlike an agent, is under the purview of audit and other compliances of IRDA (Insurance Regulatory and Development Authority) which makes the brokerage firm more accountable.

Credibility and comparison

Agent – Since an agent only sells one company’s products, he may not divulge the negative aspects of his products. He could refrain from highlighting the drawbacks to sell the policies. Therefore you cannot be 100% sure if an agent says everything you need to know. It is therefore mandatory that you check the policy wordings yourself before reaching a decision.

Broker – A broker on the other hand favors no company and will give you an unbiased comparison of different policies. You can look at all the different aspects and then make a decision. Though it is possible that a broker has so many policies that he may not know each in as much detail as an agent but in terms of credibility you can be sure that a broker will not hide facts from you as he will achieve nothing by favoring one company.

Specialization

Agent – Most health insurance agents are generallyinsurance agents who also happen to sell health insurance along with other insurance products. They may or may not understand health insurance per se in complete detail. This could prove dangerous to you, as the consumer, because health coverage needs to be done with utmost care.

Brokers – There are Health insurance broker organizations that are specialized in the field of health insurance. These brokerage firms usually primarily sell only health insurance policies so they are well aware of what the consumer wants and what they have to offer in the health insurance sphere.

Negotiation on your behalf

Agent – An agent can only present your case as is, at best, should there be a situation where you are not in agreement with any decision of the insurance company.

Broker – A broker, because of their stronger domain knowledge, can negotiate better with the health insurance company. So if you go through a broker you are a better position to get a more scientific resolution of with your needs.

Insurance Services

Agent – Agents are usually single individuals who sell the company’s products to you. As an individual they are handicapped in many ways, like he may not be able to heed to your needs immediately if he is busy elsewhere.

Broker – Brokers being organizations can afford to provide you with more services as they have more people and tend to be more systematic. They have a wider geographical reach compared to agents and are also usually associated with a team of experts from health insurance and medical back ground. . There are health insurance brokers who have dedicated teams to take care of cashless claims co-ordination, reimbursement claims processing and each such area of health insurance process.

Pan India service capabilities

Agent – Being an individual, an agent’s service capabilities are restricted to the immediate vicinity; he has to rely entirely on other agencies like TPAs if services are required in some other location.

Broker – Being organizations, most brokers have pan India service capabilities on their own steam.

Process Driven

Agent – When you are dealing with an agent, you are depending on one individual to service you. His absence or limitations will therefore impact your health insurance experience.

Broker – Brokers being organizations, you are not exposed to the vagaries of availability or otherwise of any one individual. Some health insurance brokers have end to end processes that, by speaking to any one in their team, you can get any health insurance requirement addressed.

Financial  Strength

Agent – Agents do not have to fulfill any financial criteria to be able to obtain IRDA license. As such, their ability to build service capabilities and their stakes in agency business are not high.

Broker – Brokers, on the other hand, need to meet stringent regulations governing their financial capabilities including their financial investment in their broking business. By default, therefore, brokers have larger service capabilities and greater stakes in their broking business.

Volume advantage

Agent – Because they suffer inherent limitations by virtue of being individuals and with no major financial outlay and reach, an average agent does not hold large volumes of business.

Broker – Being organizations with larger reach and greater financial outlay, brokers tend to control substantially larger volumes of business. Therefore they command better respect of insurance companies which helps you when they take up your claims or other insurance related matters with the insurance company.

Escalations within insurance company

Agent – An agent’s exposure to his company is generally restricted to the particular office of the insurance company he is associated with.

Broker – By having a team of insurance experts, brokers by and large have an interface with all levels, including the corporate offices, of insurance companies. Hence, if any of your issues with the insurance company needs to be escalated within the insurance company, the broker is in a much better position to do the same on your behalf.

Online capabilities

Agent – By virtue of a low financial outlay, an agent cannot invest hugely into infrastructure, especially IT infrastructure.

Broker – There are health insurance brokers who have rightly invested in requisite IT infrastructure facilitating online transactions for you, making your health insurance experience easier and comfortable.

 To know more about Agent vs. Broker – Who do you buy Health Insurance from

Compare & Buy Best Health Insurance Policy

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Learn to confidently complete and submit health insurance claims with this proven, practice-based approach! Realistic examples, case studies, and application exercises simplify the health insurance billing process and help you learn interactively. Instructional content is broken down into segments for easier learning, with a straightforward, conversational writing style that makes the material accessible and understandable. Accompanied by a companion CD with step-by-step claim form guidance, thi

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Leavitt: Economic factors will drive future changes to health care system
health insurance
Leavitt, who warned nearly a decade ago that the Medicare is headed for financial disaster, said the American people now accept that this medical insurance program is in serious trouble. Medicare was created in 1965 primarily to cover people over 65, …

health insurance question by synchronised: How does health insurance work in the US?
I am a non-US citizen and need this information to do a case.

Specifically:
1) Is health insurance compulsory for everyone?
2) What happens if someone cannot afford it?
3) In the event that a medical procedure needs to be done, does health insurance cover all the bills? Does the patient need to pay anything extra?
4) Does the patient have any say over what kind of procedure he can take? Say if 2 treatments are available for his condition, can the patient choose the more expensive treatment? And if so, is it covered by the insurance?

Thanks for reading this. Your help in answering any part of the questions would be greatly appreciated!
Thanks to those who have responded so far.

I would like to further ask:

Does a health insurance contract state that it will only cover the “normal” rates for a procedure? For eg. if there are 2 possible treatments for a disease, 1 of which is more expensive but more effective than the other, will the patient only be covered by the LESS expensive one?

Or is it a case in which the patient can opt for the more expensive one and “top-up” the difference?

This is a crucial question to my understanding the case. Thanks!

health insurance best answer:

Answer by Pinky Lee
Health insurance doesnt work in the US. If you cant afford it (it is very expensive) you dont have it. We do have programs to provide insurance to those that cant afford it, but it is primarily for children. You can choose any treatment you want as long as you are going to pay for it. If you do have insurance the insurance company pretty much tells you what they will pay for, otherwise you are on your own. Insurance companies rule in the US, and if you dont like it…..too bad.

Health Insurance

Health care for all protest outside health insurance conference at Moscone West

guaranteedhealthcare.org

Info about the conference they protested which included speeches form for Republican Senate leader Bill First & for HHS Secretary (and failed presidential candidate) Tommy Thompson

www.ahip.org/links/institute2008/

The Health Reform Law Promises Affordable Health Insurance to All Americans!

You are pretty clear that it is necessary for you to buy a health insurance policy. You know that considering the increasing hospital expenses and unpredictable mishaps that can happen, you need to have a health cover. You are even aware that you can purchase a health insurance policy from an agent or a broker. But you are confused as to which one you need to approach. First let us explain what the difference between the two is.

Agent – An agent is an individual who represents a particular health insurance company and is generally well aware of the different polices and packages that the company has to offer.Broker – A broker is a firm that has many health insurance companies’ policies to offer to you. The broker represents you and not any particular insurance company, and therefore compares differenthealth insurancecompany policies for you and helps choose the best one according to your requirement.

Now we give you a comparison, on basic grounds, between a broker and an agent, with reference to what they can offer you and what are their handicaps.

Individual/Personal attention

Agent – An agent is by and large an individual, catering to a limited number of clients, all within his immediate and personal reach. Therefore, when you deal with an agent you will receive highly individualistic and personalized attention.

Broker – Brokers are generally organizations; therefore, while they may score on professionalism, you will probably miss the individualistic and personalized attention an agent can give you.

Loyalty

Agent – An agent represents only one particular health insurance company therefore his primary concern is with that company and the number of policies that he sells. Your interest and need is not primary to him.

Broker - For a brokerhis primary interest is with the consumer and his needs. He represents the consumer not any health insurance company.Brokers are not concerned with any particular health insurance company as he gets paid by them all so when recommending a product, they will only have your interests in mind. They offer you a platform for thorough comparison and then help you to decide.

Knowledge and experience

Agent – To become an agent an individual has to pass an exam and though that personally gives him a fair knowledge about insurance and subsequent in-house trainings provide knowledge of his company’s health insurance policies, he does not have knowledge of other health insurance company policies.

Broker – Since a broker sells policies of all companies, he has knowledge of them all giving you a wider spectrum of choice and details. Also to become a broker the organization needs to obtain a license which is not easy and involves a lot of stringent criteria that in the process gives the broker more insights than an agent. A broker, unlike an agent, is under the purview of audit and other compliances of IRDA (Insurance Regulatory and Development Authority) which makes the brokerage firm more accountable.

Credibility and comparison

Agent – Since an agent only sells one company’s products, he may not divulge the negative aspects of his products. He could refrain from highlighting the drawbacks to sell the policies. Therefore you cannot be 100% sure if an agent says everything you need to know. It is therefore mandatory that you check the policy wordings yourself before reaching a decision.

Broker – A broker on the other hand favors no company and will give you an unbiased comparison of different policies. You can look at all the different aspects and then make a decision. Though it is possible that a broker has so many policies that he may not know each in as much detail as an agent but in terms of credibility you can be sure that a broker will not hide facts from you as he will achieve nothing by favoring one company.

Specialization

Agent – Most health insurance agents are generallyinsurance agents who also happen to sell health insurance along with other insurance products. They may or may not understand health insurance per se in complete detail. This could prove dangerous to you, as the consumer, because health coverage needs to be done with utmost care.

Brokers – There are Health insurance broker organizations that are specialized in the field of health insurance. These brokerage firms usually primarily sell only health insurance policies so they are well aware of what the consumer wants and what they have to offer in the health insurance sphere.

Negotiation on your behalf

Agent – An agent can only present your case as is, at best, should there be a situation where you are not in agreement with any decision of the insurance company.

Broker – A broker, because of their stronger domain knowledge, can negotiate better with the health insurance company. So if you go through a broker you are a better position to get a more scientific resolution of with your needs.

Insurance Services

Agent – Agents are usually single individuals who sell the company’s products to you. As an individual they are handicapped in many ways, like he may not be able to heed to your needs immediately if he is busy elsewhere.

Broker – Brokers being organizations can afford to provide you with more services as they have more people and tend to be more systematic. They have a wider geographical reach compared to agents and are also usually associated with a team of experts from health insurance and medical back ground. . There are health insurance brokers who have dedicated teams to take care of cashless claims co-ordination, reimbursement claims processing and each such area of health insurance process.

Pan India service capabilities

Agent – Being an individual, an agent’s service capabilities are restricted to the immediate vicinity; he has to rely entirely on other agencies like TPAs if services are required in some other location.

Broker – Being organizations, most brokers have pan India service capabilities on their own steam.

Process Driven

Agent – When you are dealing with an agent, you are depending on one individual to service you. His absence or limitations will therefore impact your health insurance experience.

Broker – Brokers being organizations, you are not exposed to the vagaries of availability or otherwise of any one individual. Some health insurance brokers have end to end processes that, by speaking to any one in their team, you can get any health insurance requirement addressed.

Financial  Strength

Agent – Agents do not have to fulfill any financial criteria to be able to obtain IRDA license. As such, their ability to build service capabilities and their stakes in agency business are not high.

Broker – Brokers, on the other hand, need to meet stringent regulations governing their financial capabilities including their financial investment in their broking business. By default, therefore, brokers have larger service capabilities and greater stakes in their broking business.

Volume advantage

Agent – Because they suffer inherent limitations by virtue of being individuals and with no major financial outlay and reach, an average agent does not hold large volumes of business.

Broker – Being organizations with larger reach and greater financial outlay, brokers tend to control substantially larger volumes of business. Therefore they command better respect of insurance companies which helps you when they take up your claims or other insurance related matters with the insurance company.

Escalations within insurance company

Agent – An agent’s exposure to his company is generally restricted to the particular office of the insurance company he is associated with.

Broker – By having a team of insurance experts, brokers by and large have an interface with all levels, including the corporate offices, of insurance companies. Hence, if any of your issues with the insurance company needs to be escalated within the insurance company, the broker is in a much better position to do the same on your behalf.

Online capabilities

Agent – By virtue of a low financial outlay, an agent cannot invest hugely into infrastructure, especially IT infrastructure.

Broker – There are health insurance brokers who have rightly invested in requisite IT infrastructure facilitating online transactions for you, making your health insurance experience easier and comfortable.

 To know more about Agent vs. Broker – Who do you buy Health Insurance from

Compare & Buy Best Health Insurance Policy

For the vast majority of Americans, affordable health insurance is made possible through their employers. 98 percent of all companies with 200 employees or more provide health insurance to their employees. By 2019, another 9 million with employer-provided insurance will join their ranks. People employed by large companies, companies having 200 or more employees are fortunate, in that their employer is able to provide health insurance at a discount. The number of people enrolled gives them this leverage. Up until recently, if you weren’t employed by a large company, health insurance was too expensive to obtain. That is now slated for change, big time!

The medically uninsured are so either because they are too poor and unemployed to purchase health insurance, or they are too poor, employed by a small business that can’t afford to provide health insurance without severely impacting their bottom line, or are self-employed individuals who don’t make enough money to purchase affordable basic health insurance.

Aside from being able to receive treatment for an illness when it occurs, those with medical insurance are able to get essential, early preventative treatment. Those who don’t have medical insurance will wait until the illness is critical and then go with their crisis to a hospital emergency ward. Much of the high cost of health care is precisely because of this practice. Emergency room care is the most expensive treatment you can get. If these people, waiting until their disease is an emergency, had affordable health insurance, instead of lifting the cost of health care to all time highs, they can go to a physician while the condition is still easily, and relatively inexpensively, manageable. With health insurance, they can  receive the many benefits of preventative medicine.

In addition to the practical consequences of not having affordable health insurance, there is the moral shame that so many people – 25 million at least -  must suffer with no help from their communities or their country. Life takes second place to money, and when life is viewed as cheap, the moral integrity of a country sinks. Bitterness, hatred and envy rise. The security of a nation can be threatened when too many of its people are so alienated. More than once has a crime been committed to get funds to pay for a sick child that health insurance coverage could have paid. For a safer, more caring society, affordable health insurance is a must.

To take care of this problem, the people of the United States have just enacted a law, enabling all of its citizens to receive health insurance. 0 billion has been allocated to subsidize the poor who cannot afford health insurance. Self-employed people and small businesses are also being given an opportunity to obtain affordable health insurance, through the creation of health insurance exchanges. Using the power of numbers to bring quantity to health insurers, exchanges will be able to offer small businesses and self-employed individuals medical insurance at somewhat the same rate charged employees of large corporations. Provisions are also being made to help Medicare patients weather the ups and downs inherit in the various Medicare plans. One of the most admirable provisions of the new law  prevents insurers from dropping a sick person and prevents refusals to sell a policy to those with pre-existing conditions. Rates for the sick will not be any greater than for the well. The new Health Reform Law has made the United States a more humane nation.

So available will health insurance be, the law is requiring all its citizens to be insured by the end of 2014 (with government subsidies for the poor), or pay a penalty if they are not. With such an opportunity, who wouldn’t want affordable health insurance? Start looking into it today and keep abreast of the progress of the Health Reform Law. It is, after all, a matter for you of life and health, or  illness or death. Live well, in this new era of affordable health insurance!

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Workbook for Green’s Understanding Health Insurance: A Guide to Billing and Reimbursement

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NC auditor blasts health plan practices
health insurance
By Winston-Salem Journal (MCT) — The lack of proper oversight by the State Health Plan for medical claims likely led to nearly $ 49 million in potential overpayments, the State Auditor's Office said Tuesday. The office's report was blunt in its …

health insurance question by tnfyh: What health insurance plans cover toenail fungus medication and nail removal surgery?
Hi,

I suffer from toenail fungus, and I’ve tried ALL home remedies available without success. I’m also about to buy health insurance. I thought I would take this opportunity to finally visit the doctor and get rid of this problem. My questions are:

1. Which health insurance plans offer the best coverage to treat toenail fungus?
2. Do they cover the medication and the surgery required in some cases to remove the toenail?

Thank you for all your help!

health insurance best answer:

Answer by Brian A
Since this is a pre-existing condition there is a good chance that none of them will be willing to cover it.