Declined for IFP and I don't know what to do

al3 · 10-22-2007, 11:46 PM

Had a decline today. A 52 year old man with an outdoor job as a mechanic for gas drilling rigs. Company has no benefits (not sure why.) He is well paid for this work. This is a 'vigorous' outdoor job and this guy is healthy and in better shape than all of us...except for his HBP and HCL. I think will outlive me by a hundred years!

He takes Lisinopril, 30mg 1 per day and Lovastatin 40mg 1 per day but it's no big deal. Blue Cross APSd him and after a month of waiting they finally declined him. I've tried Aetna earlier and they turned him down at pre-screen.

I can't prove it but in my heart of hearts I believe it's pure age discrimination. I can't think of the last person over age 50 I've gotten through UW on any of my carriers.

Everyone over 50 has high BP and HCL. They could have rated him up... he would have paid extra... but they didn't.

What good are these 'miracle' drugs if taking them causes you to be declined? How is he to afford them?

The MRMIP (CA state risk pool) is closed. I suppose I could try Nationwide but my bet the result will be the same.

So do I write him a UA mini-med? I'll call UA in the morning. Anyone have another suggestion for CA mini?

<editorial>
Answer me this. With MRMIP closed what am I to do? The carrier folks with their nice corporate salaried secure jobs never have to tell someone the news that if they get sick they will be 'forced' by the insurance industry... to die... or at least lose their entire life savings... to get on Medicaid. I'm beginning to think that Michael Moore got it right. If they were in my shoes and had to tell the client that there is no coverage for him, how would they feel toward the company they work for? I wonder.

My friend keeps asking why won't I join CAHU/SAHU. The answer is because it is run by the big-monied carriers and not the agents who are the ONLY ones who really CARE about this business and the clients we want to insure. For the rest of them it's just about the money.

From now on I'm only going to write GI med-sups or MA or group. IFP is a waste of my time.
</editorial>

Al

TXINSURANCE · 10-23-2007, 01:01 AM

What good are these 'miracle' drugs if taking them causes you to be declined?

Well these "miracle" drugs are expensive and this client while you might think is healthy is high risk for claims and expense. I hope he lives to 100, but it will be a pricey journey.

CA has a system I do not agree with. You can not waiver in CA which in my opinion is a huge flaw and their pool is a joke.

In most states you could go RISK POOL or HIPAA - In Texas we are spoiled with probably the BEST pool in the country - people have no idea how good they have it, yet they still complain.

Your applicant might have occupational issues as well - in some states his occupation would be a decline alone, considered high risk.

I am not showing the CA POOL to be closed, I presume you called them to get this information?

Maybe they are only accepting DOMESTIC PARTNERSHIP applications any longer - I bet that is what is going on :-)

insuremojo · 10-24-2007, 07:17 PM

Is he a 1099 employee? If so he has options...

James · 10-24-2007, 11:05 PM

Find a good Mini Plan and see if he can get a 20 grand High Deductible Plan. If not have him speak to his boss and see if you can get you in and talk about getting a group set up.

MHart · 10-24-2007, 11:58 PM

I know nationwide/health net farm bureau plan will write a plan for someone without prescription benefits so they will have the same coverage as usual just not prescription benefits. They probably need the insurance for a catastrophic event if it happens. The prescription drugs are not that expensive here are the prices below.

I use this free prescription cards go to Free Drug Card - Discount Drug Card - Prescription Drug Card - Prescription Assistance and you can look up the prices but here they are:

For lisinopril it is $38.74 for 100 quantity and $62.77 for 100 quantity his HCL

Get him this free card and he will have to spend 100 bucks every three months for drug coverage. Get him an HSA so he can write this expense off at the end of the year. Just an idea for you. Hope this helps.

Or try AIG Value Plan.

Dave020 · 10-25-2007, 07:42 AM

Did you check the underwriting guidelines before you submitted this case?

Blue Cross agent guideline states that HBP controlled with medication for at least 6 months is a rate-up or decline depending on other risk factors. I would say High Cholesterol controlled with medication (also a rate-up) would definitely fall into the other risk factors category.

I have placed three 55-59 cases with Blue Cross on less than perfect applicants in the last two weeks and all three got level one standard. There is no age discrimination here.

MRMIP is not "closed". There is a waiting list running right now about 4 months. You can thank the board of directors of the state of California for reducing the enrollment quota about 2 years ago. Back in the day the waiting list was 18 months before they changed over to the three year rule. He can still apply and wait out the few months and get enrolled on the opening. I am assuming he is currently uninsured although you didn't mention it, so how long has he been uninsured if this is the case? And if he has been uninsured, why the rush to cover if he only has to wait another four months?

al3 · 10-25-2007, 03:30 PM

Did you check the underwriting guidelines before you submitted this case?

I did a pre-screen and they did not deny him... but said they would want APS... which was no surprise.

Blue Cross agent guideline states that HBP controlled with medication for at least 6 months is a rate-up or decline depending on other risk factors. I would say High Cholesterol controlled with medication (also a rate-up) would definitely fall into the other risk factors category.

Well I would argue the risk factor here, but since neither of us are doctors it would probably be moot.

I have placed three 55-59 cases with Blue Cross on less than perfect applicants in the last two weeks and all three got level one standard. There is no age discrimination here.

That's good to hear... I've not had such 'luck.' I just look at this 52 year old who works hard, is in good shape (except for some blood chemistry) and simply don't believe that he is a bad risk. But again I'm not an MD nor do I have access to morbidity tables for his condition.

MRMIP is not "closed". There is a waiting list running right now about 4 months.

Where is that documented? I called them about two weeks ago when I first got the news and no one at the MIB could or would tell me a thing. I also called Blue Cross (who admin the program) and they also had no info. Where did you get the 4 month information.

You can thank the board of directors of the state of California for reducing the enrollment quota about 2 years ago. Back in the day the waiting list was 18 months before they changed over to the three year rule.

How long ago is 'the day'? I asked the MIP folks when the last time they had to close the pool and none of the 3 people I spoke with could remember!

He can still apply and wait out the few months and get enrolled on the opening.

I'm going to have him do that, but my guess is that this pool will be closed a lot longer than 4 months.

I am assuming he is currently uninsured although you didn't mention it, so how long has he been uninsured if this is the case? And if he has been uninsured, why the rush to cover if he only has to wait another four months?

Yes, he has been uninsured for 10 months now... and I've been after him ALL this time to do an app... but you know the 'outdoor', "nothing can harm me" type. 90% of this is his own fault. Had he put in an app when I first asked him I think I could have gotten in through Aetna as they were taking everyone back in January.

Al

GreenSky · 10-25-2007, 05:38 PM

Since he is working, he most likely qualifies for an "association" plan with Kaiser. Premium is $640 per month but has decent benefits. The commission in No Cal for this is very low, maybe $10-20 per month but it is likely available. I use this plan when I must.

Have him contact me and I'll see what I can do.

Rick

TXINSURANCE · 10-25-2007, 07:53 PM

I can't prove it but in my heart of hearts I believe it's pure age discrimination. I can't think of the last person over age 50 I've gotten through UW on any of my carriers.

Everyone over 50 has high BP and HCL.

My mom, my dad, his brother, his wife - none of them have HBP and HCL. I think this is a stretch to say everyone over 50 has BP and HCL. A lot comes down to how you take care of yourself , exercise, and stay active. Some is hereditary or roll of the dice as well - but I hear this all the time from my clients, the honest truth is there is no age discrimination (other than in the rates of course!!!).

I can get a healthy 60 year old placed easier than an unhealthy 6 month old.

I understand you are upset about the outcome but plenty of the people on this board are 50+ without BP and HCL. Even with a rate up there might not have been enough money to break even long term on the case.

It is all about money at the end of day - from the carrier perspective at least.