Open Enrollment – Confusion Spells Opportunity | APHA Blog : The Alliance of Professional Health Advocates

What a MESS Open Enrollment is this year! No matter where your health insurance comes from – an employer, the Obamacare exchanges, or Medicare – it’s changed up, switched up, and more confusing than it has ever been.

YOU, as an independent health or patient advocate or care manager live (and fight) in this world of “let’s make money from patients even if we have to deny the services they need” world. You know what it’s like having to get a treatment, or claim, or hospitalization approved for someone who has inadequate insurance coverage. You know what it’s like when they ask you to help them get a bill reduced, or when the doctor they have been seeing for years suddenly won’t accept their insurance anymore. You know what it’s like when they realize that the hospital they were rushed to in an ambulance isn’t even in their insurance network.

You understand their confusion. You may even be confused yourself.

This year we’re going to experience the added confusion of the changes the new administration in Washington has made, including reduced subsidies, reduced Open Enrollment period, and the resulting upset when people find out their current coverage is no longer being offered (several of the largest insurers have dropped out of the ACA marketplaces). And that’s just Open Enrollment. What’s going to happen when the reality of 2018 sets in, and we all have to function under the new rules?

But – here’s the good news. We are business owners! As such, we never hear negativity in the word “confusion.” Instead, when we hear the word “confusion” – we hear OPPORTUNITY!

Yes – 2018 Open Enrollment is a HUGE opportunity for all advocates – not just those who work in cost side of advocacy (health insurance / medical billing / claims, etc), but even those who work within the care side of advocacy (medical / navigational / eldercare / hospital bedside, etc). HUGE.

Why? Because everyone has to choose health insurance, and most people are clueless about how to go about it even though many have finally figured out that if they do it wrong, that it can be horribly expensive. The whole idea is intimidating.

They need a hand-holder! They need you.

Offer Simple Open Enrollment Review Services to Your Clients

Here’s how.

Ramp up on this year’s Open Enrollment challenges including dates. This article from Next Avenue is a great start. Then check out Healthcare.gov to understand the various plans available to those who are not covered by an employer, and are not age 65 or older. Then check out the Medicare Open Enrollment information available. (And, for Medicare, be sure you understand the difference between Medicare Advantage and Medigap insurance. The coverage, costs, and benefits are enormously different.) Be sure you know what dates apply to whom – start and end. Dates used in previous years may not apply.
Connect with all your clients, past and present, and even potential clients. It’s worth a few minutes of phone time, or you can send out an invitation email, to….
Invite them all to spend an hour with you going over their current coverage (to determine what worked, and what didn’t), then to help them predict what their medical needs might be in 2018, and to help them choose the best coverage for them to meet their needs in the most effective and efficient ways possible. Now – this is only an invitation. it’s not the session itself. Set an appointment for your hour, and give them a price for it. Price it knowing that it’s really a way to reconnect or further your work with them. If you’re working with them currently, you might not charge them anything extra. If they were past or are potentially future clients, then offer them something like $79 – enough to help them understand that your time has value, but not so much that they balk at the price. Ask them to have on hand any materials they have received in the mail, and copies of their current policies. Ramp up on the biggest insurers in your area. And arm yourself with those insurers’ customer service phone numbers – you may want to make phone calls during your sessions with your clients.
Spend that hour! Based on your research from #1 above, create a worksheet you can use that helps to review their current coverage, determines the plusses and minuses, then helps them narrow down their alternatives. Put together a list of questions that still need to be answered. After all – you know the questions to ask, and often, clients do not.
Find an expert in health insurance plans to pick up the ball from here. Their time with you will have helped in some basic understanding, but the nuances, the inside information, the pitfalls – those aren’t areas in which you likely have expertise. However – other advocates do! So once you have narrowed down the right questions and right challenges with your clients, connect them to someone you know and trust to take them even further. (This does not mean a broker or salesperson. Find an objective expert in the AdvoConnection Directory, or in the Expertise section of the myAPHA website.)
Afterwards, be sure to follow up. Did they follow through with their selection? If not, offer to help them do so. Do they have additional questions? Try to answer them, or reconnect them to their expert to get the answers themselves (links, email addresses, phone numbers). And – importantly – if you are an AdvoConnection Directory listed advocate, ask for a testimonial. Finally, ask if they will refer you to others who can use the help. More business!

Your goals are three-fold:

First, to be sure your clients and potential clients feel well-served.
Second, to re-cement your relationship with those clients who you no longer serve, to remind them you are there and can jump back into the advocate-client relationship at any time.
Third, to create an easy way to show potential clients the great value of working with you.

Additional ideas:

Get yourself invited to speak to senior groups or church / temple groups to talk about health insurance and Open Enrollment generalities. Make sure you provide a handout so they can get in touch with you individually afterwards. Even take your appointment calendar with you to book them on the spot.
Be sure to add their contact information to your master email list so you can continue to follow up with them.

Helping your clients choose the best insurance plan for them is an excellent investment in their well-being and your business. If they take advantage of your offer then it’s win-win. If they decide not to, then it’s still a grand gesture they will find impressive.