Illinois Mutual Simplified Issue

[cmutual]

Where both right .

Question 2A : The last yr Been diagnosed ,received or been advised to receive treatment for Cardiomyopathy

It’s modified

section C
Same question as above but 2 yrs

It’s standard


Most agents will assume if you’ve had cardiomyopathy between 1-2 yrs it’s standard


And they’ll get it issued . But the claim will be denied in first 2 yrs as they’ve probably had treatment in the past yr also .

Sorry but that insuranceman guy is correct. You have been misinformed.

Cardiomyopathy is a permanent condition. There is no scenario where an applicant who has Cardiomyopathy can answer no to questions C-1-A or B-2-A.

The format of the question is standard NAIC language carriers use (have you been diagnosed with, received or been advised to receive treatment for...).

Whether or not the client has had treatment or been advised to have treatment for Cardiomyopathy is immaterial. The only compelling factor is simply do they have it or not.

As stated, Cardiomyopathy is a permanent incurable condition and thus that question could never be answered no if they've ever been diagnosed with it.

Now I have no doubt that agents will clean sheet Cardiomyopathy clients using some incorrect logic. But that happens with all carriers.

The few agents who do clean sheet Aetna for this condition won't really affect the product's viability since Cardiomyopathy is so rare.

I've sold more FE in the last 5 years than 99.99999% of agents have in their entire life. I've run into Cardiomyopathy 2 times.

 

[DonP]

Sorry but that insuranceman guy is correct. You have been misinformed.

Cardiomyopathy is a permanent condition. There is no scenario where an applicant who has Cardiomyopathy can answer no to questions C-1-A or B-2-A.

The format of the question is standard NAIC language carriers use (have you been diagnosed with, received or been advised to receive treatment for...).

Whether or not the client has had treatment or been advised to have treatment for Cardiomyopathy is immaterial. The only compelling factor is simply do they have it or not.

As stated, Cardiomyopathy is a permanent incurable condition and thus that question could never be answered no if they've ever been diagnosed with it.

Now I have no doubt that agents will clean sheet Cardiomyopathy clients using some incorrect logic. But that happens with all carriers.

The few agents who do clean sheet Aetna for this condition won't really affect the product's viability since Cardiomyopathy is so rare.

I've sold more FE in the last 5 years than 99.99999% of agents have in their entire life. I've run into Cardiomyopathy 2 times.

I said the claim would be denied as i said agents would write it based on question 2 thinking if between 1 and 2 yrs but it gets issued . I’ve run into a few times actually 2 weeks ago . Many applicants lie and it’s out their more than we see .No different than some apps imply that your cured of copd .

 

[cmutual]

I said the claim would be denied as i said agents would write it based on question 2 thinking if between 1 and 2 yrs but it gets issued . I’ve run into a few times actually 2 weeks ago . Many applicants lie and it’s out their more than we see .No different than some apps imply that your cured of copd .

Sorry I misunderstood you comment about the 1 yr thing. I get what you're saying now.

In addition to all the policies I've sold, I've spoken to ten times more and literally only seen it twice. Crazy that you ran into it a few times recently.

 

[DonP]

Sorry I misunderstood you comment about the 1 yr thing. I get what you're saying now.

In addition to all the policies I've sold, I've spoken to ten times more and literally only seen it twice. Crazy that you ran into it a few times recently.

I wrote it 2 weeks ago modified with am am . Needed ss billing How many times have you written am am and 3 inhalers show up and they swear it’s asthma ? How about heart meds am am takes that look like Chf and it’s issued preferred. Since you’ve written so much fe you can settle this . In your exp about what % of fe claims are paid in the first 2 yrs ? I know you write a lot of accendo due to ease on telesales . How do you handle all the “ referred to underwriting “?

 

[cmutual]

I wrote it 2 weeks ago modified with am am . Needed ss billing How many times have you written am am and 3 inhalers show up and they swear it’s asthma ? How about heart meds am am takes that look like Chf and it’s issued preferred. Since you’ve written so much fe you can settle this . In your exp about what % of fe claims are paid in the first 2 yrs ? I know you write a lot of accendo due to ease on telesales . How do you handle all the “ referred to underwriting “?

Ya AmAm is very accepting of various of high risk meds that other carriers decline for such as diuretics like lasix, spiralactone and many more. You're right about the inhalers. If you put in the notes that they don't have copd and the client denies it, they will likely approve it level. But I'd agree with you that someone with 3 "asthma" meds does have copd. They are either in denial, lying or simply unaware.

To your question about contestable claims...

I don't have the exact percentage that has paid out in front of me. I'd have to run multiple reports to generate that figure and I'm not going to do that right now because I need to finish up this new piece of content I'm working on. That said, I can say for certain that at least 75% pay out because denials are not common. We are really good at risk assessment given how many people we talk to and we don't write people just because they can be approved. If we feel they are being dishonest or are very unaware of their health, we walk. Take this lady today as an example. Xarleto popped up on her rx report filled once in Nov of last year. Because of that MoO offered graded. When I asked her what is was for she guessed that it was for blood pressure. I said sorry but that is impossible. For me to help you, I'll need you to find out why it was prescribed. Then I can go to work for you and find an alternative. I left it on her to call me back. I know I could go RNA and many other carriers it would be approved, but I'm not gonna do that. My concern is she had an ROP event such as a stent, heart attack, stroke etc that she's not telling me. We are in the fortunate position to have a surplus of leads and we don't have to pay for them, so we can afford to do that stuff. That was an application that I left out there. I know most agents who are buying leads won't do that because they have to eat which I understand to a degree. Anyways, I say all this to say that our contestable claim pay out ratio is likely much higher than most for these reasons.

For Accendo, we take the application and tell the client that one of three things will happen. It's either auto approved, auto declined, or sent for review. If it's sent for review, then we'll know ya or nay within a few business days. So far, people are cool with that.

I really wish they would cut on the amount of referred cases because it happens a lot. But I'm not holding my breathe on that one.

 

[DonP]

Ya AmAm is very accepting of various of high risk meds that other carriers decline for such as diuretics like lasix, spiralactone and many more. You're right about the inhalers. If you put in the notes that they don't have copd and the client denies it, they will likely approve it level. But I'd agree with you that someone with 3 "asthma" meds does have copd. They are either in denial, lying or simply unaware.

To your question about contestable claims...

I don't have the exact percentage that has paid out in front of me. I'd have to run multiple reports to generate that figure and I'm not going to do that right now because I need to finish up this new piece of content I'm working on. That said, I can say for certain that at least 75% pay out because denials are not common. We are really good at risk assessment given how many people we talk to and we don't write people just because they can be approved. If we feel they are being dishonest or are very unaware of their health, we walk. Take this lady today as an example. Xarleto popped up on her rx report filled once in Nov of last year. Because of that MoO offered graded. When I asked her what is was for she guessed that it was for blood pressure. I said sorry but that is impossible. For me to help you, I'll need you to find out why it was prescribed. Then I can go to work for you and find an alternative. I left it on her to call me back. I know I could go RNA and many other carriers it would be approved, but I'm not gonna do that. My concern is she had an ROP event such as a stent, heart attack, stroke etc that she's not telling me. We are in the fortunate position to have a surplus of leads and we don't have to pay for them, so we can afford to do that stuff. That was an application that I left out there. I know most agents who are buying leads won't do that because they have to eat which I understand to a degree. Anyways, I say all this to say that our contestable claim pay out ratio is likely much higher than most for these reasons.

For Accendo, we take the application and tell the client that one of three things will happen. It's either auto approved, auto declined, or sent for review. If it's sent for review, then we'll know ya or nay within a few business days. So far, people are cool with that.

I really wish they would cut on the amount of referred cases because it happens a lot. But I'm not holding my breathe on that one.

Excellent underwriting. As far as my carriers am am is only one that lists any meds so you know why rop or declined . You write Lumico? If so do they have any niches ? I think they accept de cards ?

 

[noah]

New agents shy away from KSKJ because they get paid as earned.

That might be a surprise to you to I’m betting it’s not to anyone else in this business.

KSKJ is in their 129th year. I think they will make it another “3-5”.

RNA was my goto for 6 years. They jumped the shark and I moved on.

I made trinity/FBL my goto after that. That didn’t last long. Wasn’t in the cards.

KSKJ has been my goto for over 7 years now. I’ve been hearing from day 1 they wouldn’t continue.

And they haven’t. They are light years ahead of where they were 7 years ago.

You seem to think they will get worse. I believe they will improve.

If you are right I will move on to next.

I didn’t know AmAm, Americo or RNA from adam when I started with EFES.

I got all 3 at about the same time because efes pimped them. I wrote all 3.

I quickly found that AmAm was awful. Took me a little longer on Americo. Found out real fast that RNA had better value for my clients and were far easier to work with.

KSKJ provides that same value that RNA used to and are even easier to work with.

I wish they paid more. But I make more money writing KSKJ than I ever have with any company.

Do you ever get KSKJ replaced ?

I got kicked in the ass this month,replaced 3 times. Kind of unusual for me. All in Florida. 2 of them I reversed,saved. The one I’m working on saving is Moo level replaced with Oxford.

The insured wanted more coverage but Moo and other carriers in my bag are cheaper.

Have you ever been replaced and gone out there the same day you were notified and saved ,reversed it ?

Thanks

 

[jdeasy]

Do you ever get KSKJ replaced ?

I got kicked in the ass this month,replaced 3 times. Kind of unusual for me. All in Florida. 2 of them I reversed,saved. The one I’m working on saving is Moo level replaced with Oxford.

The insured wanted more coverage but Moo and other carriers in my bag are cheaper.

Have you ever been replaced and gone out there the same day you were notified and saved ,reversed it ?

Thanks

I used to get KSKJ replaced by orca agents using the fraternal and guaranty fund arguments.

I’ve always saved them. They can’t beat KSKJ on price so they use scare tactics.

We file DOI complaints on every one that’s appropriate to do so.

That has stopped most of that. I don’t remember fighting one this year.

I did have a lady call me today that’s had her KSKJ 5 years. Said there was an agent there yesterday bad mouthing KSKJ. But she sent him packing.

But I rarely get replaced on any business. I can count on one hand the times I’ve knowingly been replaced in 19 years that I didn’t/couldn’t save.

I’m sure I have been replaced and didn’t know about it. You might be surprised at the number of agents that “forget” to do replacement forms.

I contact every NSF, closed account, missed payment, requests to change to quarterly, etc. with every company.

Most of those are easily fixed.

Many times I contact people before they even know there’s a problem.

I look at every company website every morning 7 days a week. Always have. Any red flags I’m on it right away.

KSKJ is the best at notifying me of any issues. If someone calls in with their “friend “ to inquire about their cash value KSKJ sends me an email.

Trinity is good about that too.

 

[DonP]

I used to get KSKJ replaced by orca agents using the fraternal and guaranty fund arguments.

I’ve always saved them. They can’t beat KSKJ on price so they use scare tactics.

We file DOI complaints on every one that’s appropriate to do so.

That has stopped most of that. I don’t remember fighting one this year.

I did have a lady call me today that’s had her KSKJ 5 years. Said there was an agent there yesterday bad mouthing KSKJ. But she sent him packing.

But I rarely get replaced on any business. I can count on one hand the times I’ve knowingly been replaced in 19 years that I didn’t/couldn’t save.

I’m sure I have been replaced and didn’t know about it. You might be surprised at the number of agents that “forget” to do replacement forms.

I contact every NSF, closed account, missed payment, requests to change to quarterly, etc. with every company.

Most of those are easily fixed.

Many times I contact people before they even know there’s a problem.

I look at every company website every morning 7 days a week. Always have. Any red flags I’m on it right away.

KSKJ is the best at notifying me of any issues. If someone calls in with their “friend “ to inquire about their cash value KSKJ sends me an email.

Trinity is good about that too.

Moo is like Kskj I hear . I refuse to write them as they solicit your clients .If anyone even calls in asking about cash value or changing to quarterly they notify you

 

[noah]

I used to get KSKJ replaced by orca agents using the fraternal and guaranty fund arguments.

I’ve always saved them. They can’t beat KSKJ on price so they use scare tactics.

We file DOI complaints on every one that’s appropriate to do so.

That has stopped most of that. I don’t remember fighting one this year.

I did have a lady call me today that’s had her KSKJ 5 years. Said there was an agent there yesterday bad mouthing KSKJ. But she sent him packing.

But I rarely get replaced on any business. I can count on one hand the times I’ve knowingly been replaced in 19 years that I didn’t/couldn’t save.

I’m sure I have been replaced and didn’t know about it. You might be surprised at the number of agents that “forget” to do replacement forms.

I contact every NSF, closed account, missed payment, requests to change to quarterly, etc. with every company.

Most of those are easily fixed.

Many times I contact people before they even know there’s a problem.

I look at every company website every morning 7 days a week. Always have. Any red flags I’m on it right away.

KSKJ is the best at notifying me of any issues. If someone calls in with their “friend “ to inquire about their cash value KSKJ sends me an email.

Trinity is good about that too.

I’m not surprised at all that agents forget to use replacement forms. Seems like a very small percentage of agents,probably the ones that stay in it 5+ years use the forms.

Trans is pretty good about notifying me of a cancellation/replacement others I have to sift through company websites which I check almost every day.

Many that I contact have changed their number. Sometimes I am able to get the new number from CS.

Seems like companies would have a conservation dept ? Many make it difficult by having long hold times that I have lost patience with.

For me,sometimes it’s easier to buy more leads and look for better quality business.

Have you ever had the insured make an appointment with the agent that replaced,lied on you,KSKJ and then showed up to call the other agent out ?