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California Health Insurance - Independent Health Agent vs.Internal Agent Insurance Company


You just filled out an online form asking for a free health insurance quote and moments later you are inundated with phone calls from insurance agents hoping to do your business. 

Try not to be overwhelmed or annoyed by these “pesky salespeople” because they really aren't telemarketers. Most of them are state-licensed, well-trained professionals who can really help you make a good decision about which health plan is best suited and most affordable for your individual or group coverage needs.

You may be mistakenly thinking that if you buy your health insurance plan directly from the insurance company and remove the “middle person”, you will save money. 

This is absolutely not the case. In fact, insurance companies rely on agents for most of their business and that is why they pay them commissions to attract customers. It doesn't cost a dime more for a consumer to use a licensed health insurance agent in California to get their insurance coverage.

There are many differences between California health insurance and other states, including how it is applied for.

For example, while Blue Cross and Blue Shield are a corporation in other states, here in California, each is separate and individually applied as the Blue Cross of California and Blue Shield of California anthem.

The California Health Insurance Law AB 1672 is an improvement over the federal HIPAA law which covers all states in that it includes the following with respect to California group coverage:

1. People with pre-existing health problems can switch to a new group health plan with no exclusion period.

2. It allows small businesses and professional organizations to access health plans provided they have between 2 and 50 full-time employees.

3. It prevents insurance rates from climbing after filing a claim.

4. Employees who have health problems can change jobs or health plans without being rated higher for having pre-existing conditions.

Having said that, the best health insurance agent for your individual and professional needs is an "independent agent". 

Why? Because they represent several insurers, not just one. An independent agent can help you choose the most cost-effective and suitable plan with the most bang for your buck, available from major carriers, rather than providing you with a range of health plans from a company that doesn't. not meet your specific needs. A lot of people are overly complacent and settle for what their current insurance company has to offer. They could use a good independent agent to sort through the many plans available from several insurers to find and provide the best choice of options.

Another misconception you might have is that insurance agents set the premium rates for the health insurance plans they sell. Thinking that if you shop around you can get a better price for the same plan. Premium rates are based on your age, zip code or the county in which you reside and are fully controlled by insurance companies. 

Each agent uses exactly the same price guides defined by the insurance companies. The state of your health may affect your premium, which may be increased after the insurance company's underwriting department reviews your medical records. Again, it is the insurance company, not the agent, that dAnother misconception you might have is that insurance agents set the premium rates for the health insurance plans they sell. 

Thinking that if you shop around you can get a better price for the same plan. Premium rates are based on your age, zip code or the county in which you reside and are fully controlled by insurance companies. Each agent uses exactly the same price guides defined by the insurance companies. The state of your health may affect your premium, which may be increased after the insurance company's underwriting department reviews your medical records. Again, it is the insurance company, not the agent, that determines this outcome.

Now let's talk about the benefits of having a good insurance agent representing you. Most consumers do not know or understand the benefits of an offered health plan and need the expertise of an agent to fully explain the benefits to them. For example, do you know what is the difference between a "direct maximum" and an "annual deductible"?

The maximum amount you will have to pay in a given year for the deductible and coinsurance for the covered benefits before your insurance starts paying 100% of most expenses until the end of the year.

An annual deductible is typically the amount you pay each year before your health insurance plan starts paying anything for covered services. Generally, the higher the deductible, the lower the premium. Some services such as prescription drugs have separate deductibles. Plans may vary and sometimes the benefits will take effect before you have to meet the deductible.

A knowledgeable health insurance agent can walk you through the maze and help you choose the right plan to meet your needs and budget while getting the most benefits for your dollars spent. An agent will also clearly explain how the benefits of a generic prescription may differ from the benefits of a branded prescription on a particular level.

Once you have a health plan in place, a good, caring agent will remind you to pay your premium on time so the insurance company doesn't cancel you. Your agent can also be a huge resource for assistance if you have a problem with a health insurance claim. 

Instead of waiting on hold at the insurance company's 800 number for thirty to forty-five minutes, call your agent and explain your problem and if you have chosen the right agent you will get help and save money. -being a lot of time and frustration. even a little extra cash by having an expert in your area where your best interests come first.
So the next time you or someone you know fill out one of these online forms for a health insurance quote and you get several phone calls from health insurance agents who want your business, be grateful that a professional wants to help you for free to choose. the right plan and you will have a lifelong friend.

My name is Diane Le Montre, license number 0D18343, your health insurance specialist in California with over 25 years of experience. I am a licensed independent agent for major California health insurance companies including Anthem Blue Cross, Blue Shield of California, Health Net, Cigna, Aetna, UnitedHealthcare, and Kaiser.

Let me walk you through the maze of obtaining the right health insurance coverage for you, your family or your business, with an individual or group plan depending on your specific needs. I will find the best coverage for your insurance dollar by analyzing the various plans of the major insurance companies that I represent.

My experience of having worked for insurance companies as a health insurance claims auditor and being an independent health insurance agent gives me the advantage of knowing the health insurance business of both sides, from coverage to claims.

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