Aetna's Jekyll & Hyde Underwriting

[somarco]

Aetna expanded and changed their underwriting criteria in May in hopes of writing more business. The old formula was 25%, 50%, decline. Now they use 10% increments up to 100%.

At a roll out meeting they said the new formula, combined with the automated underwriting (robo-underwriter) would allow them to write cases that would have previously been declined. Some cases that would have had a 50% rate up in the past might now be 30%, making them more competitive.

Well . . .

Since implementation I have experienced more declines and HIGHER rate loads than before.

Just submitted a pre-screen on a 24 yr old with anxiety. He takes paroxetine HCL (generic Paxil) daily. This is a $4 generic drug, no counseling, no serious issues.

Aetna wanted a 40% increase. Humana says it is a standard risk.

I have had similar situations on other condtions where Aetna wants 100% increase while others are in the 50% range or less. Aetna has declined cases where other carriers were willing to take them on.

I have been wanting to find reasons to place business elsewhere. Aetna is giving me that reason.

 

[dgoldenz]

Between Aetna's higher base pricing and the 25-50% rate increases, I've yet to find a single case this year worth writing with them. Anthem BC/BS here has lower pricing across the board and the benefits are almost exactly the same. They have also taken almost all of my rejects from Humana as a Level 2 or 3 risk class.

 

[GreenSky]

I too am pretty much done with Aetna. Their underwriting has made it pretty much impossible to get anything issued quicly. They took 4 weeks to finally issue a policy for my 21 year old son and he had virtually zero health history.

The biggest problem seems to be the PHI and the people doing them. So much of what Aetna does is outsourced that there is no one to speak with on any issue.

So glad I'm back to focusing on Medicare and life.

Rick

 

[somarco]

Almost all, if not all, carriers outsource the phone interview. Not really sure why but I suppose it saves money.

They still have the hot hand here on value (rates + benefits) but they are sure making it difficult to place coverage with them.

Coventry went through the same. Blue is pretty much schizophrenic as well. Humana and GR are mostly consistent and predictable.

Cigna is fine if you can walk on water and are willing to wait a month on your policy.

 

[CHUMPS FROM OXFORD]

I'm not giving up on Aetna yet, but in the last 24 months, they (in Ohio) have gone from the lowest kid on the block 60% of the time to about 25% of the time. And their coverages are OK...not great.

 

[COInsguy]

In CO Cigna Has been blowing Aetna away, better plans & much better pricing. I'll add that while they've had some long uw times I've had my most recent 2 apps issued in under 2 weeks. One of them in 7 days flat! If they can keep this up I'll be forgetting about Aetna almost completely.

 

[somarco]

I still find it odd that carriers will run hot or cold in certain areas. A few years ago a couple of agents in CO were telling me about Humana. When they finally came to GA I found out what they meant.

Humana is still competitive, but not as much as Aetna, Cigna or (God forbid) Coventry. But their underwriting will sometimes seal the deal.

Cigna is not yet ready to be a player, at least not here. Underwriting is way too strict and a 3 - 4 week turn around is unacceptable.

Just got a pre-screen back from Aetna on a 30 yr female with a b-12 deficiency of unknown origin. Aetna says +20%, Golden Rule says decline.

This is nuts.

 

[COInsguy]

I haven't ventured much to other states, however Aetna has priced themselves out of the market for 90% of the quotes I run which I'm not unhappy about. Cigna, Assurant, Humana & Anthem seem to be the carriers that I place most my business with; followed up with Golden Rule & World here and there.

It is interesting to see how much that can swing from state to state.

 

[Crabcake Johnny]

Same in MD - tripled rates (literally) from 2005 to 2008. Now they have the "Value Plans" that launched this month. Value? For Aetna - not for the clients who get 5 doc visits per year at $50 copays.

Pass.

 

[COInsguy]

Aetna In CO rolled out the "Value Plan" along with their Calendar Year Max Plans... Save $2/month to screw your clients.. not my kind of plan.
The "Value Plan" in CO has 2 doc visits covered which is fine, however, it only has a $1,000,000 lifetime benefit, and a low ambulance benefit (Important in CO since it's not uncommon to be air lifted around here) I've had a few clients look at it on a web conference then quickly moved on.