Metabolic Syndrome

[TXINSURANCE]

I am curious do you sell a lot of individual health insurance?

Yes I do, what is your point? Client didn't disclose, how would you have handled this? Pre screens are irrelevant without disclosure.

I actually didn't mean anything negative by my comments - I was just curious if you were doing both individual and mini med / limited plans and what state you are in. The comment might have came off wrong - but it wasn't my intent.

As for how I would have handled it - I would have recommended group or state pool (in my state), this person is uninsurable on the individual market (in my state at least).

 

[bluemarlin08]

Hey TX, no problem. I only do Ind Health and a little small group, no mini med.

 

[somarco]

Metabolic syndrome, or pre-diabetic, can mean almost anything. Sometimes docs in their haste will say, or write in the record, almost anything. Too often that information is more of a wag or warning than anything but is enough to cause issues for their patient.

Her BMI is in line so that is not the issue. There could be other things triggering some of the lab results (which is where I presume the "diagnosis" came from).

If your client really wants you to help them, and they may not given their apparent reluctance to be honest, they need to get a true picture of how this diagnosis came about. Were there symptoms or did a simple lab test indicate slightly elevated sugar in the urine or blood?

Was there a fasting GTT done and if so, what were the readings? How about elevated liver enzymes or PCOS?

Even though the BMI is fine, the HTN and cholesterol can also lead to metabolic syndrome or as it is sometimes referred to, insulin resistant syndrome.

My usual approach is to give them the boot once they lie to me, but sometimes it is worth revisiting once you have a "come to Jesus" talk.

You have to decide how much this client is worth to you before taking it further or not. I am notorious for taking on challenging cases but only when I have a truthful and willing client. They have to work as hard as I do if they want to succeed. Otherwise, they are off my radar.

 

[bluemarlin08]

My gut feeling is that this is a case of doctor notes that were never conveyed to patient. Had another case recently that the patient had a cardio work up and was told everything was great. Upon receiving doctor records, it was noted that he had a dilated aorta 10% above the upper limits. We were applying for quite a bit of life coverage and no one would make an offer until an echocard. was performed. Point is, patient had no clue of the aorta situation.
Thanks for the input.

 

[somarco]

You have been doing this long enough to trust your instincts. May be more to the story or not.

Most of my clients are honest (some TOO honest). But if I had to rely totally on them to get it right I would be pulling my hair out more than I do now.

Taking a clue from the carriers, I ask for details on meds and sometimes even ask for copies of lab work before submitting anything . . . even for pre-screen. A lot of extra work, but I probably have a 95% or so approval on health apps.

And I get a lot of referrals as well . . .

 

[ins.dave]

5'11 160lb, let me know if you have any ideas.

Here's an idea.
Stop wasting time with a gimp?
Honestly, (pre type 2 diabetes)?

 

[bluemarlin08]

I have about an hour invested, win some lose some.

 

[ins.dave]

My gut feeling is that this is a case of doctor notes that were never conveyed to patient. Had another case recently that the patient had a cardio work up and was told everything was great. Upon receiving doctor records, it was noted that he had a dilated aorta 10% above the upper limits. We were applying for quite a bit of life coverage and no one would make an offer until an echocard. was performed. Point is, patient had no clue of the aorta situation.
Thanks for the input.

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True or false?
The fact is you (as an agent) can never know what the client knows or doesn't know?
Only what they tell you.
Buyers can be liars?
Their memories can be extremely selective.
For all we know her heart condition was the incentive for her to finally get off of her *ss and get her coverage?
Sometimes it is utterly amazing what comes out in the underwriting wash.
Check out this gem?
Had a "lady" (i.e. delusional b*tch) on a Humana H.S.A.
First 6 months, everything is groovy.
Then she goes in to the pharmacy to fill a prescription for a seasonal allergy which, as it turns out, she had been doing on a seasonal basis for many years. This of course is clearly a case of intentional concealment on her part.
This genius was forth coming enough to disclose that she had b. pressure / chol. issues when she applied but decided that she "didn't think that it was necessary" to disclose the fact that she used seasonal allergy medication."
The result? Humana requests doc. records for the last 5 years. As the underwriter I spoke with told me, "If she is hiding this, what else could she be hiding?"
So, the moron drops the coverage, and because it had been exactly 6 months since she had been with her previous company, she went back to it (an inferior value) for the new business rates.
So, frankly, I don't ever believe a client's rap about prior treatment entirely ever. All you can do is try to make them as clear as possible of the importance of complete discloser and then hope for the best.
If she ever called back, I would immediately hang up the phone. Not one more second would I waste on her or anyone like her.

 

[somarco]

The only real issue here that matters, or at least it would matter to me, is integrity. If the client is not going to be honest with you & let you do your job it is time to walk.

If you continue, give them a list of things to do (information to gather, perhaps additional testing) then wait on them to make the next move. If they respond, you might have a client for life and one that will refer a lot of others to you.

Quite a few clients came to me as a result of referrals, and many times the one making the referral was someone I was unable to help. But they appreciated the time I took to answer their questions and do some research.

Sometimes the sale you don't make is more profitable than the one you do make.

If not, you have invested an hour and maybe another 10 minutes.
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fill a prescription for a seasonal allergy which, as it turns out, she had been doing on a seasonal basis for many years.

H1 routinely runs Rx histories for the last 3 years. Why didn't this show up during underwriting?

Something isn't adding up.

 

[ins.dave]

fill a prescription for a seasonal allergy which, as it turns out, she had been doing on a seasonal basis for many years.​

H1 routinely runs Rx histories for the last 3 years. Why didn't this show up during underwriting?

Something isn't adding up.

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I'll give it to you. You're on it.
The truth is I can't remember if it was allergies or a reoccuring sinus condition that presented itself periodicaly. As you know, it's like pulling teeth to try and get all the facts from the client and or the underwriter sometimes. Everything else stated earlier is exactly correct.
Whatever that exact pre ex was, there was one, and she was hiding it. That's why she freaked out when Humana requested the 5 years of medical records. Humana, in my experience does probably the most thorough job of underwriting of any of the companies out here. With the exception of possibly Blue cross. I don't think they like dealing with rescissions and the like after approval. Other companies are more apt to approve without complete history and therefore rely on the 2 year period of contestability as a safety measure that much more. United, her previous company of 5 years for example.