Question on Riders

[alphawave2k]

General question for long time veterans and personal rant. Have got a young female ~ 23 that takes a prescription medicine to alleviate her menstrual cycle pain, 1-2 times during that time of the month. No other issues, surgeries, diagnosis or Rx for anything else.
I just got a notification from Coventry 1 of GA that they want to issue the policy with a rider to exclude any issues, including Rx for anything regarding the reproductive system.
This really pisses me off. How can a company in all good conscience expect a client to accept this deal?....I was told that it's life-long for that client.
Questions:
Anybody have any suggestions on carriers that would issue without this rider?
Also, will this decision impact her when shopping with other carriers? They usually ask if they have been denied, rated-up, etc. Another really annoying situation that you have to answer truthfully otherwise? How would you handle that question otherwise? This is almost collusion among the carriers, but in the insurance industry apparently it's accepted. This is frustrating, and I wonder if I could have handled this better?
One thing I know is that I will stray from this carrier as much as possible. This sucks.
Thanks in advance for your response

 

[Jabez]

Alot depends on what the prescription is. Is the drug expensive or classified as a narcotic?

 

[taterpeeler]

Aetna, Cigna... they dont rider

 

[alphawave2k]

Alot depends on what the prescription is. Is the drug expensive or classified as a narcotic?

Tramadol 50 mg per dose, 1-2 times per month. I looked it up and it seems associated with opiate derivatives, which could be habit forming, but in the dose and use levels it doesn't seem to be a big deal. I wonder if Dr.'s need to be more cognizant of the potential (insurance harmful effects)of prescribing something like this when a milder pain medication would do. I can see higher doses and more frequent use, but not at this level.

 

[dgoldenz]

Try pre-screening with Humana. Sometimes they can offer standard rates if the Rx is cheap, looks like that one is only about $10/month. Aetna/BCBS probably don't rider either, but I don't know the Georgia market.

 

[ABC]

Riders are part the game now for almost every state.

Look for a carrier that will not rider but rate up the premium.

Then compare the two plans to the client. Cost vs Coverage!

I would consider a advising a client to take a rider on that condition if there is no chance of surgery.

 

[somarco]

Surprised Coventry didn't decline her. They have the toughest underwriting of any carrier in the state.

Tramadol 50mg is $9 for 60 tabs. Makes the Coventry offer look like they are idiots (which of course they are).

Cigna will rate up 25%, Aetna probably 20%, you might get a std rate from H1.

 

[alphawave2k]

Peelerinsurance.com

Aetna, Cigna... they dont rider

Try pre-screening with Humana. Sometimes they can offer standard rates if the Rx is cheap, looks like that one is only about $10/month. Aetna/BCBS probably don't rider either, but I don't know the Georgia market.

ABC

Riders are part the game now for almost every state.
Look for a carrier that will not rider but rate up the premium.
Then compare the two plans to the client. Cost vs Coverage!
I would consider a advising a client to take a rider on that condition if there is no chance of surgery.

somarco

Surprised Coventry didn't decline her. They have the toughest underwriting of any carrier in the state.

Tramadol 50mg is $9 for 60 tabs. Makes the Coventry offer look like they are idiots (which of course they are). Cigna will rate up 25%, Aetna probably 20%, you might get a std rate from H1.

Great help you guys, I appreciate your responses and suggestions. Somarco, where did you look up the cost of that drug? I came up with a higher cost, but maybe I didn't go shopping in the right e-mart.

 

[somarco]

Humana has Rx tools online.

 

[davidleekline]

Surprised Coventry didn't decline her. They have the toughest underwriting of any carrier in the state.

Interesting in Iowa I seem to be getting better UW results from Cov than the local BCBS plan. I had one client rejected by BCBSIA and accepted as is with Cov. Cold have been a mistake on Cov's part



CRM Insurance Software - Agency Management System for Health and Life Insurance Agencies | AgencyBloc.