A Cure in Search of an Ailment

Of all the different employee benefits employers might offer, health insurance is surely the most complicated and intimidating. Everyone, including insurance carriers; federal, state, and local governments; unions; doctors; hospitals; and even, it might seem, your neighbor, has regulations, rules, qualifications, enrollment windows, and exceptions. If just thinking about health insurance makes your head spin, you’re not alone – and my friend Tess Julian of Celtic Healthcare Consultants might be cure you’re seeking.

“Health care insurance, no matter the market you’re in – individual and family, employer plans, or Medicare – is complicated,” Tess says. She enjoys being a subject matter expert, providing value for those who lack the bandwidth to navigate the health insurance markets themselves. Tess shared that she feels especially rewarded when helping small businesses provide better benefits to their employees.

Tess’ agency, if the client may need, will take on the role of being an extension of the client’s human resources department. “We’ll be as involved as the client may want or need us to be.” Tess hopes her clients will think, “Tess has our back. If we ask her agency to do something, they’ll do it.”

For many of Tess’ clients, the person responsible for employee benefits also wears lots of other hats. Many have little or no knowledge about or experience with private or government health plans, and this lack of familiarity often means they miss opportunities to save both the company and the employee money. The person who handles employee benefits may also be intimidated by our highly competitive job market that puts added pressure on employers to provide good health benefits to attract and retain employees.

Like most insurance agencies, Tess battles the client’s misconception that the services her agency offers will be paid for by the client. Many employers don’t understand that agents provide services at no cost to the client – insurance carriers pay commissions to the agency for placing policies. All the value of the services the agency provides to its client is essentially free to the client. On top of this, the employer gets the assurance that it’s complying with its obligations.

When helping clients choose an insurance policy, Tess suggests choosing a carrier that is well known, fiscally sound, and has a large provider network. She cautions to make sure you’re buying true insurance – and recommends against cost-sharing plans that may sound good in principle but may not have the wherewithal to cover large claims.

Tess is happy to make sure that the policy suits the client’s needs, and adds that she hopes to form relationships that are more than “one and done.” Tess contacts clients more frequently than at annual enrollment time and, by staying in contact, creates opportunities to provide value to her clients. For starters, Tess offers basic compliance tips, like keeping records on all employees – regardless of whether they’ve accepted or waived coverage – and keeping up with the constantly changing regulations.  In addition to these kinds of administrative help, Tess and her agency step up when needed to provide help with claims problems.

By way of example, Tess offered a tale of two unrelated children’s births – one for whom Tess and her team successfully obtained coverage by arranging for the child’s grandmother to declare the new child as a dependent so that the baby would be covered by the grandmother’s insurance, and another for whom nothing could be done to obtain coverage. In the case of the not-so-fortunate employee and her newborn child, neither of whom were a client of Celtic, the mother suffered post-partum depression and forgot to enroll the baby under the mother’s health insurance plan until after the 60-day enrollment window had passed. The baby wasn’t eligible for retroactive coverage (which is offered only in very specific circumstances, none of which applied). In this unfortunate circumstance, the mother couldn’t include the newborn baby under her policy until the subsequent open enrollment period commenced nearly a year after the baby was born, and the mother and her family bore the expense of all the baby’s medical services.

In the case with the happier ending, the baby’s mother was covered under the baby’s grandmother’s plan offered by the grandmother’s employer. The employer, thinking that the baby would automatically be covered under the plan until the newborn was enrolled, waited until the first day of the month after the baby’s birth to enroll the baby under the plan. The employer didn’t know that the enrollment should start on the day the baby was born. The insurance company initially denied coverage of the bills for the baby’s care between the date the baby was discharged from the hospital and the date of enrollment. The employer understandably didn’t want to devote the effort to fighting with the insurance company, but Tess and her team persisted and because of their persistence the insurance company paid the claim.

This example shows the lengths to which Tess and her team will go to help a client. One of the biggest challenges of serving the health insurance market, Tess says, is that people tend to think buying health insurance is the same as buying any other product or service. However, health insurance is extremely complex and highly regulated and negotiating in the health insurance market requires expertise and experience.

Tess says she especially enjoys working in the senior market that includes Medicare and Medicaid clients. Senior clients are typically very appreciative, she says, and eager to learn about their plan options. In many cases, senior clients may qualify for Medicaid on top of Medicare coverage and not even know it, and Tess can help them unlock additional benefits like free prescriptions, healthy food allowances, rides to appointments, and more. Clients and family members become very aware of the value of the benefits Tess can help arrange, saying things like, “Oh my gosh, I never knew a plan like this existed,” or “This sounds too good to be true!”

If Tess were considering hiring someone like herself, she would look for someone with integrity and who has a habit of going the extra mile for the client. Like many professional relationships, her relationships involve the client’s trusting that what Tess and her team recommend is, first and foremost, in the client’s best interest. When engaging with clients, she’s looking for businesses that employ100 or fewer employees and that are stable or, in the case of a new business, in a stable industry.

If you or someone you know would benefit from getting to know Tess, please reach out to me. I’d be honored to connect you.