If you are a status quo broker your two best friends are………………….
By Bill Rusteberg
You’ve found your mark. The employer agrees to allow you to “compete” for his health insurance business. Now you are sitting across from him about to explain your proposal when he says “Are you competitive? Let’s see the rates first.” So immediately the focus is on rates. If you pass this initial test, it’s on to the next question.
“Is my doctor and hospital in-network? ” he asks. “OMG” you think, If the answer is “No”, the sale may be lost.
Lucky for you your two best friends came through for you. You have learned through experience that (1) you will only be as successful as the underwriter wants you to be and (2) the PPO network guy has every provider on the planet on his network.
Thus, as a status quo broker your two best friends are the underwriter and the PPO network guy.
On the other hand, agents and consultants recommending Reference Based Pricing strategies enjoy a different dynamic. They only need one friend – their underwriter and his two cousins who almost always comes through for them. They don’t need the network guy since RBP plans cut these middlemen out for tremendous savings which of course makes their best friend, the underwriter, very very happy.
“But if there is no network, how can I be sure my doctor will accept my insurance?” the employer asks.
“I promise that your doctor and all the other providers in town will accept your insurance once they understand (1) they can name their own price and (2) the plan and plan member will both pony up to pay their price on a cost sharing basis” you respond. “The plan pays it’s part and the plan member pays their part. And unlike your PPO plan, the good news is 100% of all medical caregivers are eligible to receive direct reimbursement from your Reference Based Pricing plan for full plan benefits. No one is punished by reduced benefits for seeking care out-of-network because we don’t have one and quite frankly, don’t need one.”
And so it seems the purveyors of Reference Base Pricing strategies don’t have, or need, as many friends as status quo brokers and consultants. All they have is the underwriter and his two cousins, Reason and Logic.
