Humana - Contesting My Clients' Claims

[Crabcake Johnny]

I believe there's a difference. Carriers have a different standard to meet.

My wife, for example, had gestational diabetes while pregnant in '01. No meds - just watch the diet. Around 8 weeks later she was fine - diet modification solved the issue.

However, when we applied for individual coverage in '04 it was rated 15%.

Let's say she applied now with a carrier that has a 10 year look-back. She forgets about it - doesn't go on the app.

Pre-9/23 a carrier could have yanked the policy after a claims review. Post 9/23 the carrier has a meet a different standard.

That my wife left off her condition from 9 years ago that didn't even require medication would be a hard long road for the carrier to prove intent to defraud.

Remember that pre-9/23 there was nothing to say. Letter in the mail stating that per the results of the claims review the policy has been yanked. Want to fight it? Hire a lawyer.

Now, that same policy would likely never be yanked. Am I misreading the law?

 

[669comche]

I think that the legal eagles at insurance companies will utilize the "intent to commit fraud" card as frequently as they like and probably more so than they do now.

They might not actually rescind the coverage but they can make the client feel like a criminal while they "investigate their fraud". Obviously the client is guilty until proven innocent.

Its a joke. Another great example of why this great country is in trouble.

 

[HealthGuy]

I believe that Humana might try anything, even post reform to rescind policies. I don't think one damn thing has changed really regardless of the language in the bill. If the carrier can prove intent, you damn well sure they will still yank policies. Count on it in my opinion.

 

[ABC]

Carriers could always rescind for fraud or misrepresentation. Difference now is they can only rescind going forward, not retroactively.

So if you have a condition you believe you can slip by the underwriter, go for it. Get as much of your treatment paid for before they cancel your policy.

WOW I did not know this.
I thought for fraud they could decline the claims.
WOW
The 10% of people that game the system will increase the individual rates for everyone else.

 

[somarco]

Remember that pre-9/23 there was nothing to say. Letter in the mail stating that per the results of the claims review the policy has been yanked. Want to fight it? Hire a lawyer.

Now, that same policy would likely never be yanked. Am I misreading the law?

Rescissions were never as prevalent as the MSM and politicians would have you believe. It was a talking point that got a lot of face time, like apartment fires at Christmas.

Rescission were and still are serious business. They are not done without careful examination of the facts and even when the carrier is justified they are raked over the coals by the media.

Take for example Patricia Bates who was dropped by HealthNet after they discovered she was considerably heavier than listed on her app, enough so that her weight alone would have justified denying the application.

She also left off any details of a heart condition. A condition resulting from using Phen-Fen and in which she had sued, and collected, a tidy sum for alleged damage to her heart.

Of course even though HealthNet was clearly in the right by rescinding her policy they were still tarred and feathered by the press and fined $9 million.

Wonderful system we have.

The only difference now vs. then is we have a federal law, even though the feds lack the authority to regulate insurance, and it says carriers cannot retroactively rescind policies whereas before they could.

 

[jbage007]

Humana = shady operation

nothing new here folks.

 

[HealthGuy]

Humana is more interested in us pushing their new dental plans and critical illness than anything else, so really they don't have to pay claims. They must not like processing them.

 

[somarco]

Bage, is there any carrier you like or are you an equal opportunity hater? Seems most of the carriers you bash have not created any problems for me. Perhaps it is you, not the carrier that is the problem.

 

[HealthGuy]

Somarco: Why do you like Humana so much? Not being crass here I respect the hell out of you, but they are the one carrier that won't pay you on a rateup. Quote somebody at $100 per month standard, they get a stacked rateup for health conditions, the monthly is $300 and you only get paid on the $100. For all of the cracking everybody does on Assurant and Anthem they DO pay on the rateup as it should be. I don't think kindly of Humana for this commission rape. If I bring a company $300 per month in premium they sure as hell should pay me on this, not on the base rate of $100. And should I repeat: OFTEN the stacked rateups Humana levels on their indie health offers are ridiculous. Quote somebody a base rate and they repeatedly get rated 50% up with Humana or more...And YOU DONT GET PAID ON IT.

 

[Crabcake Johnny]

Who pays on rate-ups? No carrier in my state.