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Club MED
April 2025
Why I’m Retiring From Kindness 13 Years in the Medicare Insurance Business
Thirteen years! That’s long enough to realize two important things:
Annual Enrollment (October–December 2023). Clients started emailing, saying they couldn’t leave a voicemail. I checked with Angie, who told me we had 100 voice messages. So, I asked her to start clearing them out. But the emails kept coming in — “We can’t leave a message.” I checked the system myself. Sure enough, it was maxed out at 100 messages. Once it hit that limit, the voicemail system just … turned off. There was no warning or alert — it just stopped accepting new messages. As fast as Angie deleted messages, more would fill the space. It was chaos. It took a full week to reduce the backlog to under 60 messages, and we remained between 40 and 60 messages for the rest of the Annual Enrollment period. That’s when I knew I was woefully understaffed. 2024: THE YEAR OF HIRING (OR SO I THOUGHT) Determined never to relive the Great Voicemail Disaster, I set out to build my dream team. Easy, right? Wrong. Fun fact: Hiring is HARD. My nephew Jack, who works in Walmart’s hiring department, told me, “There’s a reason people do this full time.” But I figured, “How tough can it be?”
just say it didn’t work out. It turns out that the common denominator in those hiring failures was me. LESSON LEARNED: HIRING IS ONE THING, TRAINING IS ANOTHER I made a big mistake: I assumed that hiring bright, experienced people meant they’d automatically know what to do.
1. I should’ve hired help way earlier. 2. Doing everything myself for eight years was absolutely bonkers. For nearly a decade, I wore many hats — CEO, receptionist, customer service rep, IT department, complaint department, coffee-fetcher, and janitor. Looking back, I shake my head. What was I thinking?
Nope.
Here’s what I learned the hard way:
• People need training. • Training takes time. • If you don’t train them properly, it’s your fault when things go south. Owning a business is wildly complex, and I — being a slow learner — had to learn this lesson several times. BUT THEN … A MIRACLE! After a few hiring disasters, I finally struck gold. Enter Anna and Hollie. You may have met Anna already (she was in last month’s newsletter), and you’ll hear from Hollie soon — she’s just waiting on a new air boating photo for her bio. (Yes, really.) These two are excellent, kind, and genuinely dedicated to our clients. So much so that I recently told them, “Wow, you’re so kind to people. Great! Now I don’t have to be kind anymore.”
BUILDING THE TEAM Four years ago, I finally hired Angie. She was with me for four years, helping me grow the business by caring for existing clients while I focused on bringing in new ones. But talking with other successful insurance agents, I’ve realized I should have hired more help much sooner. THE GREAT VOICEMAIL DISASTER OF 2023 Angie and I were completely overwhelmed during the last Medicare
(Spoiler alert: very tough.)
The first time I hired someone — Angie — I got lucky. I only interviewed one other person. It was a total fluke.
Yep, you heard me. I’m officially retiring from kindness.
Second time around? Not so lucky. I hired three different people … and let’s
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Medicare Insurance Made Easy
402-614-3389 • 1
WHY MEDICARE CLAIM DENIALS HAPPEN AND HOW TO FIX THEM DON’T PANIC; DON’T GIVE UP
If you’ve ever received a medical bill that doesn’t seem right, you’re not alone. Many people call us when they have billing problems. However, as insurance agents, we don’t actually handle bills. That’s the responsibility of the insurance company (the payer) and the doctor or hospital (the provider). Since our clients know us but don’t know anyone at the insurance company, we get the call instead. Imagine going to the doctor, getting the care you need, and assuming your Medicare plan will cover it. But weeks later, a letter arrives: Your claim was denied. Now, you have to figure out why — and whether you have to pay the bill yourself. Unfortunately, all medical claim denials are becoming more common. Every year, insurance companies process billions of claims, but 5%–10% get denied. Some ACA Marketplace plans reject nearly 20% of claims. A recent study found that 73% of hospital billing staff say claim denials are increasing, compared to the 22% in 2022. Denied claims don’t just cause stress for patients. Hospitals and clinics also struggle, spending about $20 billion every year trying to fix these errors — many of which should have been approved in the first place. The good news? Most medical claim denials and Medicare claim denials happen because of simple mistakes. By understanding why claims get denied and how to fix them, you can avoid unnecessary stress and unexpected medical bills. COMMON REASONS FOR MEDICARE CLAIM DENIALS When Medicare or an insurance company denies a claim, they use denial codes to explain why. These codes help hospitals, doctors, and patients figure out what went wrong. Here are five of the most common reasons for Medicare claim denials. 1. Missing or Incorrect Information (CO-4, CO-16, CO-15) • Example: The claim is missing important details, such as a required code or an authorization number. • Solution: Double-check all details before submitting the claim. 2. Diagnosis or Procedure Code Errors (CO-11, CO-50, CO-167) • Example: The diagnosis doesn’t match the procedure, or Medicare doesn’t cover the diagnosis. • Solution: Make sure medical records clearly explain why the treatment was needed. 3. Lack of Prior Authorization (CO-15) • Example: Some treatments require prior approval before they can be performed. If this step is skipped, the claim will be denied. • Solution: Always confirm that Medicare or your insurance plan has approved the procedure before moving forward.
4. Late or Duplicate Claims (CO-18, CO-29, CO-97) • Example: The doctor’s office sends the same claim twice or submits it too late. • Solution: Keep track of claims and submit them on time. 5. Coordination of Benefits Issues (CO-22) • Example: If a patient has multiple insurance plans, the claim might go to the wrong one first. • Solution: Make sure the correct insurance is billed first. HOW TO FIX MEDICARE CLAIM DENIALS If your Medicare claim is denied, don’t panic! Most denials happen because of small mistakes that can be corrected. Here’s what you can do. 1. Find Out the Reason Carefully read the denial letter. It will include a code or explanation. If you don’t understand it, call your doctor’s office or Medicare to ask for clarification. 2. Correct and Resubmit If the denial was due to missing or incorrect information, ask your doctor’s office to fix the mistake and resubmit the claim. 3. File an Appeal If you believe the denial was unfair, you can file an appeal to have the decision reviewed. Many Medicare claim denials get overturned when patients provide the right information. 4. Keep Good Records Write down whom you speak to and what they say. Keep copies of letters, emails, and any paperwork related to your claim. 5. Be Persistent Medicare and insurance companies count on patients giving up . Don’t let them win! If you believe your claim was wrongly denied, keep fighting until you get the right outcome. TAKE CONTROL OF MEDICARE CLAIM DENIALS Medicare claim denials waste billions of dollars every year and cause patients unnecessary stress. But in most cases, they can be fixed!
If your claim is denied, remember:
• Stay calm: Many denials can be corrected. • Ask questions: Find out why the claim was denied. • Take action: Resubmit the claim or file an appeal. By understanding why Medicare claim denials happen and taking steps to prevent and correct them, you can avoid surprise medical bills and make sure your health care is covered.
2 • OmahaInsuranceSolutions.com
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It’s exhausting! I can’t spend all day being kind to everyone — it’s too much.
So, I’ll let Anna and Hollie handle the warm fuzzies while I focus on sales, marketing, and growing the business. In fact, they’re so kind and empathetic that I sometimes call the office just so they can be kind to me. I’M STILL HIRING! DO YOU KNOW SOMEONE? After all this, I finally feel like I’ve figured out hiring (sort of), and I’m still looking for more extraordinary people to join Omaha Insurance Solutions. If you know someone who might be a great fit, send them my way!
When getting in shape and sticking to an exercise routine can feel like an uphill battle, it doesn’t have to. Current studies show that we should strive for at least 150 minutes of moderate exercise weekly. Moderate being defined as walking 2 miles in 30 minutes or biking 5 miles in the same amount of time at a rate that requires some effort to hold a conversation. With these guidelines in mind, it’s time to reset your workout expectations with these three tips to help you find a program you can stick with. CHOOSE SOMETHING YOU ENJOY. It’s okay if lining up at dawn to enter a CrossFit gym isn’t your thing. There’s nothing worse than dreading daily trips to a weight room when you’d rather be out hiking or playing a competitive sport. The important thing is to do what you enjoy. If it’s easier to exercise with friends, ask at your gym for groups that meet there or find other people who want to work out with a group on social media. BREAK THE 150-MINUTE GOAL INTO SMALLER, ACHIEVABLE INCREMENTS. If you like jogging, rather than running for 30 minutes five days a week, substitute cycling — either outdoors or inside on a stationary bike — every other day to take the pressure off your feet and joints. Three 10-minute workouts rather than one long session is also fine. Whatever feels good for you and keeps you giving your best effort each workout. TRACK YOUR SESSIONS AND REWARD YOURSELF. Keeping a calendar of your successes helps make your good habits tangible. If you need a boost, look for different yoga, dance, or martial arts classes to incorporate into your schedule. After 30 days of success, give yourself a treat, whatever may be motivational. The bottom line is that exercise should be enjoyable if you’re going to stick with it. Don’t beat yourself up if you fall off the wagon. The voice in your head should be encouraging, the way you would speak to a friend who’s struggling. Give yourself time to establish your new routine. If you choose activities you enjoy, taking time for yourself will be a pleasure. You’ll start looking forward to your exercise routine and be more likely to stick with it over the long term. THE HIDDEN BENEFITS OF LOVING YOUR DAILY WORKOUT FIND AN EXERCISE ROUTINE YOU CAN STICK TO
Thanks for being part of this journey. Here’s to a smoother, saner future for all of us!
–Christopher J. Grimmond
Inspired by AllRecipes.com
Ginger Veggie Stir Fry
With delicious vegetables seasoned with tangy ginger, this recipe is sure to please vegans and meat-eaters alike! Ingredients • 4 tbsp vegetable oil, divided • 2 tsp fresh chopped ginger root, divided • 2 cloves garlic, crushed • 1 tbsp cornstarch • 1 small head broccoli, cut into florets • 3/4 cup julienned carrots • 1/2 cup snow peas • 1/2 cup halved green beans • 3 tbsp water • 2 tbsp soy sauce • 1/4 cup chopped onions • 1/2 tsp salt Directions 1. In a large bowl, mix 2 tbsp vegetable oil, 1 tsp ginger, garlic, and cornstarch. 2. Add broccoli, carrots, snow peas, and green beans, and toss lightly. 3. Heat the remaining oil in a large skillet or wok over medium heat. Add the vegetables and cook for 2 minutes. 4. Stir in water and soy sauce. Add onion, salt, and the remaining ginger; cook and stir until the vegetables are crisp and tender.
402-614-3389 • 3
11414 W. Center Rd., Suite 250 Omaha, NE 68144
PRSRT STD US POSTAGE PAID BOISE, ID PERMIT 411
402-614-3389 OmahaInsuranceSolutions.com Chris@OmahaInsuranceSolutions.com
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INSIDE This Issue
Why I’m Retiring From Kindness
1
Don’t Panic Over a Medicare Claim Denial
2
3
Make Exercise Fun and Effective
3
Ginger Veggie Stir Fry
4
Mastering the Art of Nature Photography
Capture Nature’s Beauty Like a Pro Quick Tips for Better Outdoor Photos
Nature photography offers a great way to get outside and capture the beauty of the natural world. Whether you’re new to this hobby or have been snapping photos for years, you can always enhance your skills with these four tips for producing compelling outdoor photos. PLAN AHEAD Before heading outside with your camera and other gear, research your chosen location and the subject you aim to photograph. Understanding the local wildlife, plant life, and weather conditions can inform your equipment selection. Timing is also key. Early morning and late afternoon, known as the “golden hours,” offer soft, diffused light that enhances natural scenes.
lines (guiding the eye with pathways or rivers), and framing (using natural elements to highlight the subject). Experimenting with different perspectives and angles can also add depth to your photos. BE RESPECTFUL Whenever you’re out in the field, respect the environment by following local guidelines, maintaining a safe distance from wildlife, and minimizing your impact on natural habitats. Always stay on designated paths and never remove any natural objects. Following a few simple rules protects wildlife and the landscape and maintains the integrity of your photography. With these tips in mind, you’re ready to enjoy the outdoors while capturing images that reflect the beauty of the natural world.
MASTER YOUR EQUIPMENT Be sure to familiarize yourself with your camera’s settings. Some of the most important include aperture, shutter speed, and ISO, which control exposure and depth of field. For instance, a wide aperture (low f-stop) can help create a shallow depth of field and isolate your subject from the background, which is particularly effective for wildlife photography. Conversely, a narrow aperture (high f-stop) is ideal for landscape shots because it increases the depth of field and helps keep more of the scene in focus.
CONSIDER COMPOSITION In photography, composition is key.
When taking nature photographs, apply compositional rules such as the rule of thirds (placing subjects off-center), leading
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