Med Supp for a client taking a blood thinner?

[Thomas Mead]

I have a client that had a stroke in 2016 and was put on Clopidogrel and never taken off. He has no history of A-Fib, DVTs, or anything else that would be a contributing factor for another stroke or clots. He is otherwise a picture of health and wants to switch from his advantage plan to a plan G since his wife's plan works so well for her. I know Humana will give an instant decline with this med, does anyone know of a company where a blood thinner with no recent or chronic illnesses might be approved? I don't have the Medicare toolkit since I mostly write T-65s and don't need research tools very often.

I really appreciate any help you can provide.

 

[goillini52]

I have a client that had a stroke in 2016 and was put on Clopidogrel and never taken off. He has no history of A-Fib, DVTs, or anything else that would be a contributing factor for another stroke or clots. He is otherwise a picture of health and wants to switch from his advantage plan to a plan G since his wife's plan works so well for her. I know Humana will give an instant decline with this med, does anyone know of a company where a blood thinner with no recent or chronic illnesses might be approved? I don't have the Medicare toolkit since I mostly write T-65s and don't need research tools very often.

I really appreciate any help you can provide.

According to the Toolkit, looks like he's SOL. Try BCBSTX, seems like they're more lenient than other carriers.

 

[Kstatemike]

Most cariers will take him. Go through there knock out drugs and if it is not on there they will take him. I know Lumico, Great Southern Life, Cigna, and I think Aetna would although it is a knock out drug only if he has peripheral vascular disease. Pick a company and submit him, should not be a problem

 

[Bob L]

There's always UHC -- they will take lots of folks other companies decline if he can pass the knockout questions. Premium may be high, however.

Gotta say that I literally cannot remember the last client wanting to switch from an MAPD to a Med supp -- it's nearly always the other way around these days. More and more people with premiums that are higher than the max OOP.

 

[somarco]

Most cariers will take him. Go through there knock out drugs and if it is not on there they will take him. I know Lumico, Great Southern Life, Cigna, and I think Aetna would although it is a knock out drug only if he has peripheral vascular disease. Pick a company and submit him, should not be a problem

How many times have you submitted an underwritten app for someone taking an anticoagulant (clopigel, Plavix, coumadin, warfarin, heparin, etc.) and had it approved?

 

[Cenla Agent]

There's always UHC -- they will take lots of folks other companies decline if he can pass the knockout questions. Premium may be high, however.

Gotta say that I literally cannot remember the last client wanting to switch from an MAPD to a Med supp -- it's nearly always the other way around these days. More and more people with premiums that are higher than the max OOP.

And few people are hitting the MOOP year after year. Most often you hit it for a year or two and then recover and become more of an average utilizer, or else..........

 

[Cenla Agent]

He says there is no contributing factor to a future episode. His medicine cabinet (and his doctor, evidently) says otherwise. That's the way UW looks at it. Some people are still on meds that they don't really need to be on. Whether he really needs it or not, he is going to have trouble getting approved, maybe no matter how long ago the stroke occurred.

The fact that a prospect's drugs aren't on the KO list can be cause for optimism, but it is no guarantee that he will be accepted. The KO list is a tool that tells you not to even bother submitting an application. Just because an app isn't going to be auto-declined upon submission is no guarantee that it will be approved. A lot of KO lists aren't as detailed as we'd like either. It may not be a KO to be on a drug for one condition but it is a KO for another.

As mentioned above, on Toolkit, currently taking clopidogrel for stroke appears to be a KO for every company that they have information for. (They don't have that info for United and BCBSTX.) With most companies, it is a KO if taken within 2 years.

If it was angina, heart surgery (but not a heart attack,) or thrombosis instead of a stroke, a handful of companies might take a look at someone on that med if there isn't some other KO. But in that case Toolkit says that it could (I'd almost guarantee would) cause the case to be sent to an underwriter or could cause an adverse decision.

 

[somarco]

Most often you hit it for a year or two and then recover and become more of an average utilizer, or else...

Except for those who die . . .

 

[Cenla Agent]

Except for those who die . . .

That’s the “or else….” scenario.

 

[Kstatemike]

How many times have you submitted an underwritten app for someone taking an anticoagulant (clopigel, Plavix, coumadin, warfarin, heparin, etc.) and had it approved?

I would guess I have somewhere between 50 to 100 clients taking one of those medications. 80% of my book is underwritten and I am one of those that I make the underwriting do their job. If my client can answer the questions on the app and there are no knock out drugs, I submit it and make the company say yes or no. I have multiple times put an app in with one company and had it declined and then put in with another company and had it auto approved.