4. Is Your Broker Really Championing Your
Cause?
No matter what the field, relationships with brokers
usually are complicated. Health insurance renewals are no exception. It is typical for brokers to have
divided loyalties between their employer-clients
and their insurance company “friends.”
The conflict goes straight to the bottom line. The
more an employer pays in premium, the more the
broker recovers in fees. No employer sitting at the
renewal table can afford to forget that fact.
Due to the complexity of health insurance renewals
and the other issues competing for an employer’s
time, most employers are forced to rely heavily
on their brokers to analyze renewal offers and ask
the hard questions. But as a practical matter, an
employer should be clear about where the broker
sits — sometimes literally. If “your” broker arrives
and leaves the renewal meetings with the insurance
company representatives and, during the negotiation, sits on the opposite side from you, take note.
Further, with health care in flux because of the Affordable Care Act, even brokers willing to help may be
ill-equipped to do so. This is a time when brokers have
no choice but to be educating themselves fully about
the ongoing changes in law and regulation. If your
broker is the type to sit on the sidelines, approaching
the post–Affordable Care Act world just as he or she
did before, it may be time to get a new one.
Ask your broker questions before your renewal
meeting — questions about how your medical loss
ratio was calculated, whether the numbers match
the records as to the claim and enrollment history,
how to unpack a quote, the facial legitimacy of
any alleged trends, and so on. If you are dissatisfied with the answers, consider other options, like
retaining an insurance consultant or attorney to
assist you.
5. You’re Not Alone, But That is No Reason
to Wait
Many, if not most, corporations purchasing health
insurance have not traditionally followed the approach that is proposed here. The level of complexity involved in these issues is beyond dispute. The
best evidence is that the government regulators,
who are the reigning experts, keep pushing back
implementation of the enforcement components.
But we are living in a new world of health insurance — and there always is time before your next
renewal. If you re-set your focus on these issues,
accept that the Affordable Care Act is here to stay
and start learning about the various ways that the
statute can be of help, you should maximize, or
at least improve, your company’s position at the
renewal table. s
The authors are experienced in representing employers against health insurance companies, from the
renewal negotiation through litigation of payment
disputes. Both attorneys have dedicated their careers
to the representation of policyholders.
Rhonda D. Orin is the managing partner in Anderson Kill’s Washington, DC, office. Ms. Orin has
secured stop-loss and other insurance coverage for
corporate policyholders in connection with employersponsored plans. She has recovered millions of dollars
for policyholders in connection with environmental
cleanups, asbestos insurance recoveries, property
claims and business interruption claims, among others. As trial counsel in 2002, she won one of the 10
largest jury verdicts. Ms. Orin is the author of Making
Them Pay: How to Get the Most from Health Insurance and Managed Care (St. Martin’s Press 2000).
202-416-6549
[email protected]
Daniel J. Healy is a partner in An derson Kill’s
Washington, DC, office. Mr. Healy has litigated
insurance coverage for employer-sponsored health
plans to jury verdict. He also has secured coverage
for disability claimants, environmental and asbestos
liability, directors and officers insurance, errors and
omissions claims, health care plans and other losses.
As a former prosecutor for the Justice Department, he
has extensive experience trying cases in courts across
the country.
202-416-6547
[email protected]
VOLUME 12 | ISSUE 1
7