Insurance 101
What does HMO, PPO, and EPO stand for?
Health Maintenance Org
Preferred Provider Org
Exclusive Provider Org
Name 5 Mental Health meds
Lexapro
Prozac
Wellbutrin
Zoloft
Xanax
Overweight
Got it, so for the sake of the application there is a height and weight guideline when it comes to elevated blood pressure. So, im going to give you an extra inch to keep you in guidelines.
How many plans do we offer?
SA
PA
PC
HA
What are my siblings names
CJ + Bel
Name 4 types of competitors (not networks)
Short Term - Golden Rule
Employer - LifeX
Marketplace - BCBS
Medishare - Christian Ministry
Name 5 HBP meds
Lisinopril
Metoprolol
Amlodapine
Losartan
Hydrochlorothiazide
Do I have to go with the policy if im approved?
I dont think I understand your question, are you not sure you want to proceed with the policy? Or are you wondering if theres a minimum commitment?
NOT SURE - Okay, just so I can understand, would you say its the coverage or the price thats making you unsure?
MINIMUM COMMIT - So there is a 3 month minimum on the plan, but its month to month, you dont pay for anything until the day the coverage begins.
Explain the difference between payout months vs advance months
Payout - The amount of months it takes to pay off you debt with the company
Advance - The amount of months your advanced in commission
What degree did I get and from where
Psychology - Ohio State
What is the definition of a deductible, co-pay, premium and max out of pocket?
Deductible: the amount of money the client has to pay before benefits kick in
Co-pay: the set amount of money the client has to pay, on top of the premium, for a specific service such as Dr Visit
Premium: set amount client pays monthly for the plan
MOOP: Stop loss - the absolute worst case scenario maximum amount client will pay for the year
Spell out HCTZ
Hydrochlorothiazide
Not comfortable giving my banking information over the phone
So the insurance company does require a valid form of payment on file in order to apply, I can’t move forward if I wanted to. They are currently paying $200 per applicant to pull medical records, so they do need to confirm you have a valid form of payment. Does that make sense?
Extra 100 points CREDIT CARD
Yes, you can, but there's a 10-12% processing fee, and you will be charged today instead of the start date of your policy. Also, you will have to call in every month to pay your premium, instead of getting it automatically draft. it's kind of a customer service nightmare so most of my clients prefer to use their account and routing.
What are the 5 MOOPs on SA with 80/20
$4,500 • $5,750 • $7,000 • $9,500 • $12,000
What does fta stand for?
Field Training Agent
What is a QLE & what are they?
Qualifying Life Event:
Lost or losing coverage
Change in household size
Change in primary place of living
Plan error
Offered an HRA or QSEHRA
What is spironolactone prescribed for
HBP + Acne
Will it cover my psychiatrist?
Yep, no worries, so as long as they're in network you’re always going to receive your in-network rate which typically reduces the bill 50-80% which is a massive discount for anything psych related - the only thing you won't receive is that additional $100/ $125 benefit, since it’s not considered a doc visit. Does that make sense?
Great, you also do have access to 3 free talk visits with MDLIVE that you could also utilize!
OR
Great question, what I recommend is you start with the FREE visits that you're going to get virtually on the telemedicine with MDLIVE, you're going to get three of those and then after that it'll be $90 for an hour for virtual visits after that. Now if you want to see a Doctor in person, You will get the contracted rate but you won’t get any additional benefits so it might be better that you pay cash for those visits but you can run it through the insurance to get the contracted rate.
Example, you’re billed $250 and the contracted rate brings it down to $80, Does that make sense?
Now how often do you see yourself going to see a therapist? Multiple times a week? Maybe Once a month?
Oh ok perfect this would be the ideal plan then. If you want to get unlimited mental health that's comparable to this plan it would be $300/$400 more per month, so it’s better off paying cash rather than paying for another plan that's more expensive where they make you pay for it all up front until you satisfy an 8 or 9k deductible first. Does that make sense?
*Mental health is better on employer plans, where it is just a copay
What are the 4 types of bonuses
Par, Quickstart, Aces, Production
Whats my favorite animal
Shark
Name the 10 essential items for something to be ACA compliant
1. Maternity
2. Rehabilitation
3. Mental Health
4. Ambulatory
5. Prescriptions
6. Hospitalization
7. Pediatrics
8. Wellness
9. Labs
10. Emergency Services
Name 5 decline meds
ALOSETRON
METFORMIN
INSULIN
MELOXICAM
KEPRA
METHADONE
NALTREXONE
VIVLODEX
SUBOXONE
PLAVIX
RISPERIDONE
TRUVADA
VIVITROL
DITROPAN
ABILIFY
CALONPNOIMALINC
I dont want any United Health Care plans
I understand, did you have a bad experience with them in the past?
(yeah, they didn't cover my yadayada) "Ah, got it — that sounds like it was a public Marketplace United plan.
On the public side, insurance companies underwrite at the time of the claim — which can sometimes lead to denials or surprises.
With private insurance, underwriting happens up front, at the time of the application. That means they review your health before approving you, so once you’re accepted, your claims can’t be denied, they would just decline you as a whole.
Does that make sense?
Explain the following to a confused client that doesnt understand their insurance card and each part
- US Health Group
- Optimum
- Freedom Life
- United Health Care Choice Plus
- US Health Group = body of advisors
- Optimum = your prescriptions
- Freedom Life = the underwriters
- United Health Care Choice Plus = the network
If I could pursue any career in the world what would it be?
Tornado chaser