Underwriting Resources Guide The long awaited (my bad on that one) guide to underwriters tools to analyze your clients medical and lay issues. Ranked in approximate order of efficacy:
MIB Reports: Perhaps the murkiest of all resources. This is a service all carrier pay into to act as a smoke signal to prevent unscrupulous individuals from defrauding us. If a history gets you rated two tables to a decline, draws a flat extra, or causes benefits to be declined or rated its supposed to be reported. And even if you ask the policy be declined as unwanted coverage we’re still supposed to report it if we saw it.
The easier codes to deal with are those from a doctor’s records; you can order specifics from that carrier and pursue those records and see what they saw. The bigger problem usually results in codes reported from another carrier’s labs (side point-never ask State Farm for their labs; they just won’t send them). I’m sure most of you have had someone busted by MIB for a prior tobacco code at some point. This one gets hairy as there are two codes for tobacco (one for admitted use and another for a positive urine/saliva specimen) and the latter is even MORE complicated because there’s no uniform standard for who is and isn’t tobacco across the industry. Some companies have higher/lower nicotine thresholds, some companies make infrequent cigar smokers Tobacco yet… it can be a tricky path to base a rating off of unless you obtain something else (i.e. the records or specific labs in question).
In the end you’re not supposed to base your decision ONLY on the code. It’s only supposed to be an indicator to tell you something’s potentially up. In the FE world I know some sacrifices are made for the sake of issuing the coverage, but that should lead you to a PHI, records, or a Pharm Scan. Which leads us to...
Pharmacy Reports/Rx Scans: Participating pharmacies/health plans report the scripts you fill, who with them with, and the dates you fill them. So unless you pay cash, go to a hospital pharmacy, or don’t really have anything filled ever… it won’t show anything.
The trick here is to watch medication and purpose. If you’re getting Lamictal or Depakote from a neurologist you probably have a history of epilepsy/seizures that needs further investigation but isn’t making me too nervous initially. On the other hand if it’s given by a psychiatrist, I’m pretty much guessing without reading the other medicals on the file that you’re bipolar or very far down the road into a high-end depression that may need to be evaluated like it’s bipolar.
PHI: Cross your fingers with phone interviews. These people can get your clients to admit things they won’t tell their priest. I net more tobacco and marijuana users from these than from the Medical/Paramed or APS I’d say at a rate of 8:1. People also tend to get brutally honest about their incomes and financials at this point as well.
APS (Attending Physician Statement): Usually the “gold standard” but they have their pratfalls for underwriters and agents alike.
FOR AGENTS: If you insists we order the records on a client (for whatever reason)... you’re inviting us to open Pandora’s box. It’s all fair game if we chase the records, not just for one issue. If we find out they smoke? Too bad, it’s Tobacco. Documented as binge drinking and advised to cut down? There’s a confidential rating letter. CBC’s or other blood tests or out of whack? You’re gonna get rated because now we have the trend. So if you ever get that client who is scared of needles and wants you to chase his records; do so with due trepidation.
Another note: Not every provider gives us everything and not every specialist gives everything we need. I’ve had files that needed four sets of records before we fleshed everything out. Doctors records’ departments are also inconsistently staffed; sometimes they take 4-6 weeks just to review the request then only send the last visit (when we request five years of records). It’s a joy testing their reading comprehension skills sometimes.
FOR UNDERWRITERS: We can take things like social history out of context. Ever had to fight a tobacco rating in a set of records? They have a bad habit in electronic records of just carrying their notes forward and not updating them so it looks like your client never stopped smoking.
I’m like leaving tons out so feel free to ask away. Only thing I ask is don’t request that I interpret an MIB code out in the open here. We can discuss it in a private message if you care to.
MIB Reports: Perhaps the murkiest of all resources. This is a service all carrier pay into to act as a smoke signal to prevent unscrupulous individuals from defrauding us. If a history gets you rated two tables to a decline, draws a flat extra, or causes benefits to be declined or rated its supposed to be reported. And even if you ask the policy be declined as unwanted coverage we’re still supposed to report it if we saw it.
The easier codes to deal with are those from a doctor’s records; you can order specifics from that carrier and pursue those records and see what they saw. The bigger problem usually results in codes reported from another carrier’s labs (side point-never ask State Farm for their labs; they just won’t send them). I’m sure most of you have had someone busted by MIB for a prior tobacco code at some point. This one gets hairy as there are two codes for tobacco (one for admitted use and another for a positive urine/saliva specimen) and the latter is even MORE complicated because there’s no uniform standard for who is and isn’t tobacco across the industry. Some companies have higher/lower nicotine thresholds, some companies make infrequent cigar smokers Tobacco yet… it can be a tricky path to base a rating off of unless you obtain something else (i.e. the records or specific labs in question).
In the end you’re not supposed to base your decision ONLY on the code. It’s only supposed to be an indicator to tell you something’s potentially up. In the FE world I know some sacrifices are made for the sake of issuing the coverage, but that should lead you to a PHI, records, or a Pharm Scan. Which leads us to...
Pharmacy Reports/Rx Scans: Participating pharmacies/health plans report the scripts you fill, who with them with, and the dates you fill them. So unless you pay cash, go to a hospital pharmacy, or don’t really have anything filled ever… it won’t show anything.
The trick here is to watch medication and purpose. If you’re getting Lamictal or Depakote from a neurologist you probably have a history of epilepsy/seizures that needs further investigation but isn’t making me too nervous initially. On the other hand if it’s given by a psychiatrist, I’m pretty much guessing without reading the other medicals on the file that you’re bipolar or very far down the road into a high-end depression that may need to be evaluated like it’s bipolar.
PHI: Cross your fingers with phone interviews. These people can get your clients to admit things they won’t tell their priest. I net more tobacco and marijuana users from these than from the Medical/Paramed or APS I’d say at a rate of 8:1. People also tend to get brutally honest about their incomes and financials at this point as well.
APS (Attending Physician Statement): Usually the “gold standard” but they have their pratfalls for underwriters and agents alike.
FOR AGENTS: If you insists we order the records on a client (for whatever reason)... you’re inviting us to open Pandora’s box. It’s all fair game if we chase the records, not just for one issue. If we find out they smoke? Too bad, it’s Tobacco. Documented as binge drinking and advised to cut down? There’s a confidential rating letter. CBC’s or other blood tests or out of whack? You’re gonna get rated because now we have the trend. So if you ever get that client who is scared of needles and wants you to chase his records; do so with due trepidation.
Another note: Not every provider gives us everything and not every specialist gives everything we need. I’ve had files that needed four sets of records before we fleshed everything out. Doctors records’ departments are also inconsistently staffed; sometimes they take 4-6 weeks just to review the request then only send the last visit (when we request five years of records). It’s a joy testing their reading comprehension skills sometimes.
FOR UNDERWRITERS: We can take things like social history out of context. Ever had to fight a tobacco rating in a set of records? They have a bad habit in electronic records of just carrying their notes forward and not updating them so it looks like your client never stopped smoking.
I’m like leaving tons out so feel free to ask away. Only thing I ask is don’t request that I interpret an MIB code out in the open here. We can discuss it in a private message if you care to.
