Wednesday, July 23, 2014

Patient Dignity 07: A Broker Addressing Malpractice As Medicine Addresses Modesty

Let me start off by saying I am qualified to talk insurance premiums. For what I do, I decided to get all the insurance licenses my home state offered. It was a CYA move, so that I did not want risk being accused of being involved in insurance transactions without a license. At one point, I was a licensed broker in 20 states (for a specific project). I did not do health insurance, my specialty dealt with "work comp" insurances. 

 This is a cumulation of most of the complaints that patients have about the treatment of their dignity. This is satyrical and always, from the patient's point of view.  Most providers are just good people caught in a bad system. Changes that I advocate not only ensure patient dignity, but frees the physicians from the system to ensure the protection of patient dignity.

As more practices that were partnerships can't afford med mal/liability, they are selling to large healthcare corporations. Practitioners of the Healing Arts are becoming employees. I chose this narrative because you as a provider feel that you have been treated in this manner. You may have had some of the same, exact experiences and infractions committed against you.

I realize that some references may seem silly, but you are an intelligent, educated professional, and you will get the gist.

As a physician and a partner in a practice, would you find this aceptable???

An Insurance Broker Tells His Physician Practice Clients, in a Letter, What Really Happens

Dear Physician Practice Client,

Recently there has been posts on many internet blogs by physician practice groups bashing brokers and agencies. While most brokers and their support staff are honest, caring, professional, people, there are some (more than we like to admit, even more than we know), who give our profession a bad name.

We are just as guilty as them because we were brought up in a system that teaches us to ignore human emotions, we just look at the body of numbers. We attribute these infractions to the atmosphere we work in: big corporate agencies trying to run insurance like a fast food chain, insurance companies that keep negotiating lower and lower commissions, excessive workloads, the constant threat of Errors and Omissions lawsuits, continuing education credits, and so on.

I also do not see that many of these criticisms are valid, but I am looking from the inside out. Because I don't believe that they are valid, I don't try to see them either despite the overwhelming evidence staring me in the face.

We are accused needless ignorance or calloused disregard of the client's emotional well being going through a difficult process. We are not working in garage on automobiles here but with real live people who in all probability have never been through the initial application process and what happens is pretty distressing.

Renewals are easy, just sign and accept. You will definitely have to go through this process again if you get dropped. The "Big Insurance Association" recommends that even if you are getting renewed to go through the complete application process, annually to prevent future problems.

Many of my decisions on your coverage use to be influenced by commission rates, bonuses, MGA contracts, and contests with vacation prizes. Those days are pretty much gone. Being a carrier rep does not have the prestige that it use to.

I am sorry that  your malpractice/liability/work comp/EPLI/D&O/E&O insurance expires and is being non-renewed. I know that this is a scary situation that you may not be familiar with, but as your licensed insurance broker, I am charged to serve you, the partners, and the practice; my client,  first, in your best interest, professionally, and ethically.

You may feel humiliated being in front of me and my team with no insurance to cover you. That is only to be expected. You need to realize that we are working to save your practice, you need to stop being silly and put your feelings aside. We don't see the value of your feelings in this matter when you may lose your practice.

The first thing that I need to do is put together an application. I am going to have to ask you some very personal questions about the practice and the people working there. You may think that these questions are unrelated to your application, but as a professional, I need this information as part of the application process.

I will be asking you about education, finances, accreditations, employment practices, billing, accounting, criminal backgrounds, and so on of the partners, the practice, and the employees. This is necessary for me to look for any red flags that might pop up. We may have to run some tests on your employment policies. These may be unpleasant, but again all we are focusing on here is you not losing your practice.

I will also be examining some very intimate parts of the practice, like the finances of the practice and of the partners. I will try to remember to tell you everything that I do before I do it. At any time if you are uncomfortable, I will stop. I may not realize that you are uncomfortable about these issues, I may not be talking with you during this, just pushing foreword.

You may feel embarrassed about what I find, but don't worry, "I am a professional and I have seen it all before." I will try not to expose areas unless I have to. You need to realize that in order to do my job properly and serve you completely, I need to look at these areas even though other brokers might not and it might even not be necessary. Yes I can put together an application without them, but I do a complete forensic exam, my choice. If you are uncomfortable with that, perhaps you should seek out another broker.

I tell all my clients "I can tell a lot about your business by examining these intimate parts." We can get a healthy picture of the practice now, it will be easier to diagnose and prevent problems in the future. I may also request records from previous providers, like audited financials from your accountant. It is my choice how I conduct my application process.

I create a file about your practice with all my info, notes, application, and I may even come out to your practice to take pictures. We may identify certain rooms in your practice, but we do not take pictures of anything that identifies your practice. We may use the pictures and information we collect on your practice in scholarly studies to predict future risk, but you already agreed to all that in the "broker of record" form that you signed.

Very few people are comfortable having a complete stranger see their very private tax returns and other stuff, but I was taught the correct way to do this, so you have nothing to worry about. They are just numbers. I am not judging you based on this. I only look at one section at a time. I know that some people on the internet describe this as an anal probe and say it is too intrusive based on their financial modesty issues.

To make you feel better about your embarrassing situation of not being covered (by insurance), I may have this chap, alone, from my office with me when I have your folder open, looking at your stuff and doing the application procedure. This is for your protection and for mine. I don't want to be accused of "fudging your numbers" or "having my hand in your cookie jar." You might be more uncomfortable with this, but rest assure, I am not (it's NOT my stuff being looked at).

I keep this information in a manilla folder to protect your financial modesty. I know that manilla envelopes can open accidentally and expose your stuff, but as a "matter of efficiency," that is what we use. Yes, there are "interoffice clasp envelopes, but they are too inconvenient for us. Manilla envelopes cover enough up.

There are also going to be other members on your team here getting your submission together, you really don't need to meet everyone of them. They should introduce themselves when dealing with you, but they may not because they have too many clients heaped on them. Just so you know, they will be poking through your stuff. This also includes carrier reps who may be with me looking at your stuff showing me how to fill out a new insurance application.

We also have interns (trainees). These are people studying to get their insurance licenses. There is an obligation to train new brokers, so we have them working with us. They will be poking through your stuff too. Most brokers won't tell you they have trainees or who they are so that clients just assume they are brokers too. That saves us having some uncomfortable conversations with the clients. 

I know that you want to know about my finances and lifestyle, but that is my personal information, and it is not professional for me to share. Even though it would build enormous trust by me filling out an application, showing you my tax returns, putting my money where my mouth is, I wont because I don't have too. I have this plastic model of an application or a brochure that I can show you.

Negotiating our professional relationship, involving you in decision making, foregoing some painful parts of the process, giving you more control, and going through the process WITH you would build trust, alleviate your fears, and allow you to endure some of the painful and humiliating parts that you thought you would refuse.

But that means giving up control. I am a sales professional, a type A personality. I was taught that as soon as you get resistance from a client, get their information in a manilla folder and the humiliation and power imbalance will make them compliant. It also helps that I am in a suit, looking like a professional and you are in your pajamas (scrubs). In the good 'ole days, you would come in, show me your stuff, and I was in control from there.

I will also politely order you to do certain things, like "sign here." If you refuse, then I just repeat the order, in a stern, matter-of-fact voice until you comply. I am the authority figure, and I need to act as such.  Asking, although more respectful, gives you the opportunity to say "no." Then I need to explain myself, you are deluded in thinking that you can refuse. Again I was taught this too, but you will not find it in any book.

When I went to school, we never did applications on each other. Although it would have made us better brokers, given us a better understanding of what you go through, our paternalistic attitude prevented us from doing that. We did do superficial stuff, like figuring out the SIC codes of where we currently worked, but that is all.

Some teachers allowed us to process applications with their personal information. Mostly we had actors come in and we practiced on them . Other than that, you get experience as an intern. The broker who taught me would wait until the client was out (of the building), then me and four other interns would pull back his manilla folder and poke through his stuff.

At first I had a problem doing this, but my mentor said that since we were affiliated with a business school, this was a teaching agency. There was also informed consent, in the fine print in paragraph 49 in the "broker of record" agreement that the client signs.

You may feel depersonalized. We are taught to do this to solely make choices based on logic, fact, observation, science, and the numbers. You need coverage, and this is the coverage that you need. You don't want the deductible, but you won't get coverage without it.

We are all insurance professionals, but we are human first and foremost. That means we have curiosity, stresses, and make mistakes. Most of our administrative assistants are young, female, and immature. We will tell you they are professional. They will look through your stuff, will gossip about it, laugh about it, and may even post it on FaceBook.

If you are a middle aged man or older, or fat, you will be a source of entertainment for some of these young people, especially the women. If your manilla folder is bigger than most, they may be calling other admin assistants to look at it. They will present with a legitimate reason to look, and they are most likely entitled to look, so deal with it in the furtherance of education.

We  expect them to act as professionals. We can do more, but that takes time and money. Besides, we feel that we are doing enough to protect your privacy. I am not sure either exactly how often this happens, so it may not be a problem at all. The industry never studied this.

If you are a woman that is a partner in a practice, and especially if you are attractive, you may notice brokers coming over to talk to your broker. Your broker may even call a consult with other brokers if he feels that he needs to. This is normal. You should not feel uncomfortable, they are all professional.

The fact of the matter is that most of our brokers are men. Most of our admin assistants are female. We would like to hire male admins and female brokers, but their numbers are limited, therefore your choices and wishes are limited too.

In a busy office, people will see your stuff. That is just a fact of life. We could do more; private offices, clasp envelopes, better training, but we don't. That is because WE don't see a problem with your stuff being exposed. If you have a problem with it, then there must be something wrong with you.

If you come into my office, you consent to my entitlement to dig through your business. If you don't follow my directions, then you are noncompliant and I cant work with you. Here is the phonebook, good luck finding another broker, after being labelled a "bad risk."

I know that you want more, but I don't know what "more" is. That is because I never bothered to ask. I assumed that we are doing enough by saving your practice. To be honest, your emotions and financial modesty are just interfering with the process.

The Internet talks about making insurance consumer driven, but as an educated, licensed professional, and an arrogant SOB, I reject that. You are not a consumer, you are an "insurance client." Besides, I don't work for you, the insurance company pays me (commission).

You do have options. This is not extortion. There are many out there doing without vaccine insurance. There is speculation that this is due to backlash against the industry. Sorry, but if you don't have  vaccine insurance, I can't take you on as a new client or I will have to drop you if you are already a client.

I have seen predictions that a future trend will be many practices choosing the "Florida option," that is walking away from agencies because they are unhappy about the way they feel that they are being treated.

Welcome to our agency.

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