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Bait & $witch, Part 2

Thursday, May 10, 2018 6:10
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In Part 1, we revisited the story of Sally and Dave, who had decided last summer to ditch their grandmothered major medical plan in favor of a Health Care Sharing Ministry. While searching for alternatives, they ran across a Texas-based agent with … questionable … claims and offerings. The first plan she offered turned out to be a standard issue Short Term Medical (STM) that didn’t actually match what she’d originally promised.

But along with that product, she also sent along information on a mini-med (limited benefit) plan. Like the STM, this is also non-ACA-compliant, and once again she failed to mention this crucial fact. Here’s part of her pitch:

Philadelphia American Plan Level 2 Highlights … Doctor’s office visits are approximately $25… (plan pays $60 after PPO network discount) … Plan pays for outpatient tests like blood tests, MRI’s, immunizations, x-rays, etc. – (You receive the PPO discount plus plan pays $20 to $350 per test)” and the (impressive) list goes on.

I have no real objection to these cash plans (indeed, they used to be fairly popular), but again, she’s pushing this as an ObamaPlan replacement without mentioning the pitfalls, or even that this is not a major medical plan at all. Yes, Sally should read the brochure that the agent attached, but therein arises another major problem: it also fails to disclose that it’s not ACA-compliant (and remember, she’d becoming off a product that is).

Now here’s where it gets really egregious: turns out that the brochure the agent sent was incomplete, and omitted two rather important caveats found on subsequent pages:

Pre-existing conditions are specifically excluded for the first year, and there’s a laundry list of “Exclusions and Limitations.”

This is beyond the pale.

Oh, just how do we know this? Because co-blogger Bob found the actual, complete brochure which included these rather significant items.

In fact, this story has actually evolved from “Bait-and-Switch” to “Egregious Agent Tricks.”

How’s that?

Well, the email also included the agent’s “3 part guarantee:”

Part 1- Our 100% Satisfaction Guarantee: If you are not 100% satisfied with the company you select, we will gladly place you with another company of your choice and if there is an application fee, we will cover the cost up to $25.00.

Part 2- Meet or Beat Rate Guarantee: After we find a plan that meets your needs and budget, if you find another company offering the identical coverage for less, we will meet or beat any price.

Part 3- No Obligation Guarantee: All of our plans are month-to-month with no long-term contracts. So you can rest assured that you are never trapped in a long term agreement.

Co-blogger Patrick picked up on this right away:

Did you see the “3 part guarantee” at the end of the email? Who can actually offer a meet or beat guarantee? And never mind the fact that every insurance contract I’ve written is always month-to-month based on paying on time.”

Indeed. First, the promise to find alternate coverage is problematic: these are all medically underwritten, so if one develops a pre-existing condition in the meantime, what then? Also, the promise to pay any “fee” seems seems to be skating awfully close to the rebating line. And the “meet or beat” promise is silly: rates are rates (unless we’re back to rebating…).

All in all, methinks that Sally and Dave dodged a major bullet.

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