"Everything proceeds as if of its own accord, and this can all too easily tempt us to relax and let things take their course without troubling over details. Such indifference is the root of all evil." (I Ching). I learned this all too well while working on a group health insurance package for a non-profit agency several months ago. Now mind you, I'm a stickler for details. But an issue came up that knocked me over the fence and into the parking lot. This article was written to generate some "what would you do?" comments. So, read and write back as you see fit.
The quoting process started months before the actual effective date and I did my due diligence in getting the employees to complete a couple of different insurance carrier applications for firm quotes. The client and I finally agreed on a competitive carrier and it was time to hone in on specific benefits. This was a labor-intensive process since the client was really struggling to provide benefits to the employees on a tight budget. Quotes were flying back and forth like a paperboy's arm in a hurricane. My client needed a lot of options, but we finally zeroed in on a set of benefits they were comfortable with and they could afford. I actually counted the number of re-quotes at 12.
Since the effective date of coverage was now looming, I completed the employer application and all the supporting documents and sent them off to the carrier. The last piece was the final quote from the carrier. Once I received that, I quickly ran it over to the client for a final sign-off and we were on the home stretch. All I had to do now was wait for the issuance and then do the employee meeting. I was glad to get this one on the books!
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The policies came in a week before the effective date, and I scheduled the employee meeting right away. My talking points were based on the final signed quote as the employees scrunched into a tiny room with smelly carpet and a flickering fluorescent light bulb. After a few minutes of discussing deductibles and co-insurance, one of the employees piped up and asked about the four-visit limit on doctor co-pays. You could have shocked me with a stun gun and I wouldn't have felt it! During the back and forth quotes, we had been illustrating an unlimited doctor co-pay schedule. The insurance carrier had stealthily issued a final quote that limited the co-pays to four visits, and the client and I didn't make the catch at the time it was signed.
Needless to say, I was really miffed at the carrier for doing this and hated to learn of the error during the employee meeting. I repeatedly tried to reprimand the carrier into going back to the original benefit, but they advised that the client signed the final quote and there was nothing they could do other than re-issue and raise the rates based on the unlimited co-pay. I also blame myself for not catching this error before I had to do the "Shymkus Shuffle" in an employee meeting. In my haste to put this case to bed, I failed to consider that the devil is in the details. My client did not make an issue of it and we are still on great terms . My question to you is … how would you have handled this situation? Is the insurance carrier in the wrong? Did I bungle a normally ordinary sales process?
In any event, please read the terms of your client's health insurance contract … before the employee meeting!
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