I have a case I am working on and wanted some feedback:
I have a customer that was on HBP meds, overweight, and had a death in the family and was put on Lexapro and Wellbutrin about 6 years ago. She of course was declined by a couple of carriers and went to the Risk Pool.
She was taken off the HBP meds about 3 years ago and has had normal blood pressure readings since, lost the weight and is within standard weight requirements, and is currently still taking the Wellbutrin and Lexapro, but has never been hospitalized or anything with those conditions.
She is about to have to drop the Risk Pool due to the cost and I wondered if Assurant would look at this. It appears she lost some weight and everything else went back into check like John P. is always talking about.
I am thinking about submitting an app with a 25% load and seeing what underwriting says. I am sure I'm looking at an APS on this one, but I wanted to see what input you all might have on the possible underwriting outcome.
She's still taking Wellbutrin AND Lexapro? You're looking at more than 25% and a load for meds if you're gonna quote Max or HSA. Quote CoreMed and there's no action since mental disorders aren't covered but that should not be an option for her.
Assurant will also consider that she's been off HBP meds for three years but their radar will definitely be up. I'd say this is a rough Assurant ride but you're looking at 50% plus for a rating to start the bidding.
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She's still taking Wellbutrin AND Lexapro? You're looking at more than 25% and a load for meds if you're gonna quote Max or HSA. Quote CoreMed and there's no action since mental disorders aren't covered but that should not be an option for her.
Assurant will also consider that she's been off HBP meds for three years but their radar will definitely be up. I'd say this is a rough Assurant ride but you're looking at 50% plus for a rating to start the bidding.
Yes. Wellbutrin and Lexapro are actually a pretty normal combo for depression... at least with docs around here.. both low dosages. So you think CoreMed is a no-go only because it does not cover mental or nervous disorders? Would it not be an option if she is to the point of dropping her coverage anyway?
Do you have a recommendation for another company that might look at this risk more favorably?
Also, the 50% minimum rating you're talking, would that be due to the fact that she is on the mental drugs and was on HPB meds...?
I'm not a fan of clients have having coverage for on-going conditions. Only in a last resort situation. I'd be looking for Assurant's HSA or Max Plan then Aetna and check on Blue Cross. Clients can become hospitalized for depression-related events and it's nothing you don't want coverage for.
Sorry to sound rude, but a death 6 years ago requires her to still be on two depression meds?
No action for the HBP if she's been off the meds for 2 years. The reason for the possible 50% load is her total health history over the past 5 years along with the two depression meds. But I'm actually checking with my underwriter for you.
I'm not a fan of clients have having coverage for on-going conditions. Only in a last resort situation. I'd be looking for Assurant's HSA or Max Plan then Aetna and check on Blue Cross. Clients can become hospitalized for depression-related events and it's nothing you don't want coverage for.
Sorry to sound rude, but a death 6 years ago requires her to still be on two depression meds?
No action for the HBP if she's been off the meds for 2 years. The reason for the possible 50% load is her total health history over the past 5 years along with the two depression meds. But I'm actually checking with my underwriter for you.
Thanks John... Yeah, she said that the depression started as situational, but of course, anything over a year is not situational so who knows..
Thanks John... Yeah, she said that the depression started as situational, but of course, anything over a year is not situational so who knows..
Situational is 6 months to a year. Anything over that is chronic and medication alone isn't the answer.
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[COLOR=#000066]"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
Consumers have to realize that doctors have an incentive to prescribe medications. Talk to a pharmoceautical rep and see how they go about making a living.
This is not to say that drugs can't help because they can, but people ALWAYS want the quick fix....
It's the doc. My wife and I have been together 24 years. In 1990 she was diagnosed bipolar. I had no clue, but quickly became an expert. Why? Because of all the docs, interns, etc. that need help themselves, it's like the blind leading the blind! (sorry). In my opinion all that the shrinks are good for nowadays is a script. You NEED an advocate, someone who is normal, understands you and your illness, and cares enough about you to be proactive about it. My wife has a good doc now, but he has dropped the ball a few times, I called him on it, he agreed and apologized. We have a good relationship and it works very well for my wife. I can only wonder what sick folks do when by themselves they are at the mercy of this "establishment". We have been through so many freaky doctors in 17 years (some of whom I could have initiated malpractice against - but why add the extra trouble, since I caught and corrected the bumble?) that I have come to the general conclusion that apparently a LARGE percentage of folks who majored in psychology/psychiatry in college, did so to try and figure THEMSELVES out, and failed to do so.
------------------------------------ Nature has established patterns originating in the return of events, but only for the most part. -- Gottfried von Leibniz 1703 Under similar conditions, the occurrence (or non-occurrence) of an event in the future will follow the same pattern as was observed in the past. -- Jacob Bernoulli Ars Conjectandi 1713
Last edited by JSF : 06-07-2007 at 11:31 PM.
Reason: typo
We have been through so many freaky doctors in 17 years (some of whom I could have initiated malpractice against - but why add the extra trouble, since I caught and corrected the bumble?) that I have come to the general conclusion that apparently a LARGE percentage of folks who majored in psychology/psychiatry in college
I hope you do understand that there is a huge difference between psychology and psychiatry. Unfortunately, you get a bad mix of therapists, counselors and psychiatrists no matter where you go. The latter wants to say, "take these pills and you will feel better," while the latter says, "we should talk about what is bothering you."
that I have come to the general conclusion that apparently a LARGE percentage of folks who majored in psychology/psychiatry in college did so to try and figure THEMSELVES out, and failed to do so.
No argument there. Probably 50-60% of all psych majors I have encountered were studying psychology to to help understand themselves. Although I disagree with the failing part as you are making a generalization and it seems like you have some pent up resentment.
No, no pent up resentment, just high expectations that were not met. All has been well for 7 years (since 2000). Actually very well since we got the system figured out. You are right, made a generalization based on a local, specific situation. Sorry!
P.S. Yes, I understand the difference between the two professions. During the process I read 7 books related to the condition. Six were pro-chemical and 1 was pro-"talk". Pretty much matched the real-world experience. No offense meant. If you've never been in that situation with a close loved one, it was probably the most frustrating period in my life. That being said, I probably learned, grew, and matured more at that time also. So I actually do not have any regrets, from that point of view.
P.S. Yes, I understand the difference between the two professions. During the process I read 7 books related to the condition. Six were pro-chemical and 1 was pro-"talk".
Here is the litmus strip test. Which type of book advocates a cause that raises revenue vs. awareness and education?
Pretty much matched the real-world experience. No offense meant. If you've never been in that situation with a close loved one, it was probably the most frustrating period in my life. That being said, I probably learned, grew, and matured more at that time also. So I actually do not have any regrets, from that point of view.
I am experiencing very similar situations with some close family members and it is tough to go through. I still maintain my position and think a dual treatment is applicable. Problem is that most psychiatrists are not trained in psychotherapy and only a few states allow psychotherapists to prescribe medication. Here are a few links that coincide with my perspective
Using medication as a stepping stone and as a support system can and does help people, but you do encounter a problem with people becoming dependent on drugs.
Show me somebody with bi-polar, ADD, ADHD, etc. who only takes medication and does not have any behavioral or cognitive therapy and I will show you somebody who has a very difficult time navigating life. It really is a shame that there is a stigma about counseling, but it is culturally acceptable to take pills. This is in no way a reflection of how I feel about your wife so I hope you do not take it that way.
P.S.S. During 10 years we saw a LARGE cross section of providers, she was in and out of all the psych wards and mental health centers around here. No one ever psychoanalyzed her. Fortunately the chemicals work. However, as she had an episode, they just added another drug, lithium, depakote, risperdal, about 10 in all. Eventually at one point her body chemistry just freaked and she was in ICU next to death for 3 days. The bright side of that is that they stopped all drugs, and when she was stabilized they started with a new one (at the time) called Zyprexa. That one has worked wonders on a smidgeon of a dose. It causes weight gain, and type II diabetes (she already got both by the time it was discovered that this drug can contribute to these maladies). So they have added some other drugs to control these things, but the only psychotropic at this point is Zyprexa. Stable for 7 years now. No complaints. But before then it was hit or miss. Different drugs work for different folks, so they sort have to hit or miss until they find what works. I would not want to be in their shoes. Again, I think it is very important to have an advocate, if possible. There is 75% non-compliance by patients regarding their drugs (not my wife!) and every time we are at the dr. office there are SEVERAL no-shows, just in the few minutes we are in the waiting room. I can't imagine how many patients there are out there that are non-compliant and/or have no help, but that is just my limited observation. If anyone out there reading this is going thru this with someone or has any questions, please feel free to PM me, and I'll help answer as best I can. That is really my reason for posting, did not mean to sound as if I was complaining. We overcame and got a handle on it. And we still take it one day at a time. And my wife is very compassionate for those with her same condition. She is actually very selfless and helpful to other patients when she is around them. It's amazing to observe. Guess she knows what they are going thru. She is a stronger Christian than me, that's for sure!
There is a lot of research that needs to be completed about the efficacy of medications. There are way too many variables that is nearly impossible for doctors to know the consequences of using various drugs on people.
Here is the litmus strip test. Which type of book advocates a cause that raises revenue vs. awareness and education?
I agree, it was 6 to 1 in favor of revenue...
Originally Posted by salpro22
I am experiencing very similar situations with some close family members and it is tough to go through. I still maintain my position and think a dual treatment is applicable. Problem is that most psychiatrists are not trained in psychotherapy and only a few states allow psychotherapists to prescribe medication. Here are a few links that coincide with my perspective
Our "good guy" is a psychiatric MD. We were never able to find a psychologist, and knew anyway that they could not prescribe.
Originally Posted by salpro22
Using medication as a stepping stone and as a support system can and does help people, but you do encounter a problem with people becoming dependent on drugs.
Show me somebody with bi-polar, ADD, ADHD, etc. who only takes medication and does not have any behavioral or cognitive therapy and I will show you somebody who has a very difficult time navigating life. It really is a shame that there is a stigma about counseling, but it is culturally acceptable to take pills. This is in no way a reflection of how I feel about your wife so I hope you do not take it that way.
I take no offense at all, JR, and appreciate your friendship on this board. My wife now navigates life very well. I don't want to toot my own horn, but I suppose I have taken the counseling role (daily) for her, and I think it works very well, but you would have to ask her! The weird, or maybe not so weird thing, is when she would have an episode of total decompensation, it was like I was not there (invisible), in other words, she never focused any animosity toward me (she would certainly let others "have it", she has a strong personality) and when no one could get her to do anything (take her meds, etc. total rebellion), I knew how to get her to do it. Again, a close advocate helps, at least in this case. We met when we were both NOT Christians, so we like to say the devil put us together, but God worked it out and kept us together. She needed me, and I needed her (I was/am crazy in my own way, but we won't get into that!)
Last edited by JSF : 06-08-2007 at 01:20 PM.
Reason: typo
Not seem too cold, but sometimes some perspective is needed. Somewhere in this world today someone was convicted for a crime they didn't commit, somone will be exectuted without a trial, someone's child was abducted, and someone will watch their child die of starvation. I'm not saying that major phychological conditions don't need attention, but this "depression" stuff is mainly a load of horseshit. You want depressed? Go to Somalia and walk 5 miles in the morning to get water. A friend of mine is on depressing meds - housewife with two kids, nice house, nice life. Just having touble "coping." Maybe a two weeks in Somalia would cure her.
Interesting in that I just finished a book titled "Talking Back to Prozac". Peter R. Breggin. Written by one of the few psychiatric drug experts in the country without ties to the pharmaceutical companies.
The drug companies are truly evil people. There's no evidence that antidepressants are especially effective as treatments. In the majority of FDA studies, Prozac proved equal to or only a little better than a sugar pill but a lot more hazardous.
And approved for sale. They have no idea of the long term effect of these meds. Everyone is essentially a guinea pig. How about side effects that don't go away after the meds are discontinued?
You can't heal the soul with a medication and the definition of what is normal is becoming increasingly constricted.
Apparently it is rare for a depressed individual to commit suicide but usually occurs when the person is agitated. These drugs have been activating and energizing depressed people beyond suicidal ideation.
I agree about perspective. I'm on the board of our Homeowner's Assoc. and on one of the circles there is a fight brewing over what to do about altering the "natural" island in the middle that is pitting neighbor against neighbor. I was tempted to reply to an email that was sent around about it: "The terrorists are at bay, the economy rocks, the weather is good; so let's argue about the island". Perspective.
I know depressed folks. I bet Paris is depressed. I think a large part of society today gets depressed if they can't "get what they want right now". I know where ya comin' from. Clinical depression? Don't know, never been there. But I do know bipolar manic episode. I call it "part-time schizophrenia", since they are not manic all the time. A total decompensation and the individual peaks with no sleep for days, has no idea who they are nor any concept of reality, totally unable to function in society, then totally crashes and becomes non-responsive. That is a bipolar episode. They say it is chemical. They treat it with chemicals. Seems to work empirically. Thank God. As far as "regular depression" I can snap her out of that in 5 minutes. It's all in how you think (or in how someone helps you think). But this bipolar thing is a pretty major thing, if you've never seen it full tilt. There was a movie called "Mr. Jones" wherein Richard Gere played a bipolar man. My wife and I saw it (she was okay to see it, else we wouldn't have). Men are much more violent, the movie was pretty accurate, but really didn't take the manic part far enough, nor the non-responsive part either. I understand there was a movie with Patty Duke portraying herself as bipolar, but I only remember the scene where she destroyed the Christmas tree. The hardest part about it is really caring for someone and watching them go thru it, especially when you don't know what's going on. After 17 years I am an expert and I know her so well, that even a wisp of what they call "breaking thru" occurs, and I know, and I know how to prevent it (knock on wood), usually with talk and perhaps an extra dose of meds (under dr.'s orders). MUCH more controlled when anticipated and know what's coming. Used to we had to let her totally decompensate before they would admit her to the hospital (before we found her current dr.), that was the pits, and the first thing they would do is administer liquid Haldol (something like an elephant tranquilizer) that just made her a zombie, but definitely knocked out the manic episode. She said her brain felt like it was on fire. It probably was.
Well, we've come a long way since "One flew over the cuckoo's nest". Or have we? She tells stories from the early days when admitted to the mental hospital and visting hours were over (middle of the night, etc.). Don't know whether to believe her or not. If true, it's their word against a "mental patient", no matter how temporary.
But I agree with you, in fact that is my strategy alot of time to lift her spirits if they start to "fade", I bring perspective about her situation and how really good it really is. She always agrees. It works. Because it's true.
And I haven't mentioned it in this thread (I don't think) but that doesn't even begin to take into account that fact that whatever physical (or mental) malady may beset us, sickness is "death in operation", and death IS inevitable (unless Jesus returns while we are alive). She is a strong Christian (people make fun of her when she gets sick - "look at the crazy Christian!") but we KNOW life is like a vapour; this suffering, however light or heavy the affliction, will soon be past, and eternity will be totally different, good beyond our comprehension. THAT faith has helped her more than anything (to the consternation of many "worldly" and "educated" professionals) to maintain a normal life and be able to interact with society, despite the medications. Think what you may, but that is where it stands today.
How did we get on this subject?
I need to get back to studying this board and insurance, reading all the REAL posts, learning from you guys, thank you to all the great folks on here, and....where's that HSA webinar?
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