A financial advisor recovers $76,000+ in healthcare costs for their client

Financial situations change quickly, which is what makes annual reviews a core component of the value offered through financial advisors. There are ‘standards’ to address, but what does it look like to go above and beyond? Well, one advisor based in California introduced healthcare into their review framework, and for him, there’s no going back after implementing a strategy that led to recovering a client $76,000. 

In the review conversation, the financial advisor (let’s call him Frank) recognized that their client’s healthcare expenses were high. He gently asked the client if they wanted to share more, and they opened up about a new diagnosis in the family and expressed concerns around having the appropriate health insurance coverage for their needs. Frank knew this was an opportunity to deliver value, but didn’t necessarily have the skillset himself to address this. Scrambling for options, the advisor reached out to Caribou, a healthcare planning tool for financial advisors.

Running a financial analysis through their platform revealed the insurance structure of the family and identified a gap, which luckily could be modified. Here’s a snapshot:

• The father was on Medicare, while the mother and their two children were insured through Covered California, the state Marketplace, which didn’t include as rich of benefits as the previous employer plan. This can be a common situation, especially if the income-earner in the household is older than their spouse. 
• Their high out-of-pocket expenses were driven from the youngest son who suffers from a chronic condition. His condition was rare, so they frequently received insurance denials regardless of the insurance plan.
• The actual line items that were driving the high costs were predominantly the son’s out-of-network providers. They used in-network providers when possible, but few doctors had experience with it, meaning that they needed to seek doctors and facilities that weren’t within the plan’s network.

So what was Frank able to offer as a solution? He presented his clients with a financial analysis outlining the best plan options to optimize their coverage for the year. This was projected to save the family thousands of dollars. But it didn’t stop there. One particular out-of-network cost immediately stood out from the rest. Their son’s condition had progressed and their in-network provider had advised the family to undergo a special course of treatment. They searched and searched for a doctor but every in-network provider indicated that they weren’t able to deliver the care their son needed, leaving the only option to be an out-of-network provider in a different state.

After reviewing the policy and clinical notes, an opportunity was recognized to appeal the insurance denial for the out-of-network provider on the basis that appropriate network care wasn’t available to them. An appeal was filed through Frank’s partnership with Caribou, whose team did all the heavy lifting, seeing through documentation and communication with the insurance company. The denial was overturned, resulting in a full refund of more than $76,000 to the family.

Takeaways

More than half of Americans struggle to navigate the complexity of the healthcare industry, triggering avoidable and more costly care. Lack of education on health insurance, overtreatment and billing mistakes are only among a few of the most common issues impacting clients’ wealth. 

Not every client will deal with an exceptional circumstance like the one outlined in this story but healthcare will affect everyone, each with their own set of specific needs. Taking the time to assess your clients’ needs beyond typical areas of focus, such as investment advice or estate planning, will uncover opportunities to differentiate your practice and deliver added value to your clients.

To touch on clear learnings from this case study:

1. Suggest that clients keep records of interactions with insurers when trying to obtain approval for care. This includes the date, the representative’s name and the reference number of the call.
2. There are no guarantees, but appeals are almost always worth considering if clients have the will and believe there are grounds to press on. Financial advisors are the perfect liaison to connecting clients with experienced professionals that can help in the decision of pursuing an appeal and in the appeal process itself. 
3. Persistence counts! It’s hard to go through this process when the result isn’t assured. Patience is necessary because it can be slow, but it is so meaningful to the client to know their advisor truly is looking out for them.