I got a call from a former client. The family of four has gone without insurance for 18 months. They've been paying cash for medical services. Hey, there's nothing wrong with paying cash, if they know about the risks of being uninsured. But what galls me is that now the Mom calls and says, "I need health insurance with no pre-ex". Red flag. Seems the 11 year old boy has been having seizures, and they've been paying for the Dr. visits and Rx in cash. But now, the boy's seizures are unusual (one eye stops working during a seizure), so the doctor says they want to hospitalize him and take him off all Rx, so that the hospital staff can witness the seizures and see what's going on. Doctor tells client, "Now is the time to buy health insurance". The client fully realizes that there is no longer a pre-ex clause for kids, and calls me to buy insurance now. The parents are insurable, so some insurance company is going to get stuck with the medical bills for the kid. So far, this is my first "fully informed" person who is clearly gaming the system. These people are buying insurance "on the way to the hospital", and they are fully aware of the new laws regarding no pre-ex for kids. Where does the cost curve end? Will this double our premiums? Triple them?
They're Gaming the System Already
- Thread starter Ann H
- Start date
- 4,716
It all boils down to one thing Americans have the entitlement mentality when it comes to health care. No cure for that.
- 630
It must have been so tempting to rant at them but I know you are a professional and would never do that! Guarantee they will drop the coverage once this is resolved, if whatever it is is controlled/cured.
Welcome. I'm not sure why you call it "gaming" the system. This is the way the system is designed. You do realize that most of the State and Federal option risk pools are insuring people that have enormous medical bills, upcoming heart surgery, pregnant etc.
This will not change once the exchanges and GI get here. It will only increase, because there will be more places to get covered for everyone.
You need to work harder to pay their subsidies, they're not going to be paying their premiums either. Get two jobs if you need the extra money.
- 1,931
Don't see how we can complain about someone playing by the rules. The problem is the rules.
Here is another consideration.
Since they have been paying cash, medical records won't be in MIB files. If they wanted, they could lie on the application and say nothing is wrong.
Of course the carrier will investigate once the first claim is filed and then has the option of cancelling coverage (but not retroactively) or retroactively increasing the premium to the max load.
Depending on the carrier you use, that could mean $0 commission for you on any of the family members.
My advice would be send them to PCIP and go to your next REAL prospect.
Bill and fastpitch are right. They are not gaming the system any more than I do when I write a 2 life mom & pop group because mom, pop or both are uninsurable. I have several 2 life groups with guaranteed 150%+ loss ratio's.
I also have HIPAA clients with similar situations.
Guess I am a gamer.
Since they have been paying cash, medical records won't be in MIB files. If they wanted, they could lie on the application and say nothing is wrong.
Of course the carrier will investigate once the first claim is filed and then has the option of cancelling coverage (but not retroactively) or retroactively increasing the premium to the max load.
Depending on the carrier you use, that could mean $0 commission for you on any of the family members.
My advice would be send them to PCIP and go to your next REAL prospect.
Bill and fastpitch are right. They are not gaming the system any more than I do when I write a 2 life mom & pop group because mom, pop or both are uninsurable. I have several 2 life groups with guaranteed 150%+ loss ratio's.
I also have HIPAA clients with similar situations.
Guess I am a gamer.
M
MichiganAgent
Guest
Let's not forget MANY of the Health Insurance companies are just as guilty. There has been a news story about United Health care. A man worked in aerospace industry, got downsized, and paid his COBRA faithfully ($1600 per month!) to keep his coverage since wife was pregnant with twins.
Twins were born in May. Wife goes to first dr. office visit after birth, and was told she didn't have insurance. Goes home, calls company, and was told they were dropped since they did not inform the company the family grew by two memebers! Every time I had a kid the insurance company knew right away I had a new member, since they were paying the damn medical bills!
That's not all: they cancelled the family retroactively to February! It was a difficult pregnancy so the family now owes $500,000 in medical bills.
They end up filing bankruptcy, losing their home, and moving in with mom and dad. After the story got picked up by NPR and a couple of other news outlets, UHC said, "...they would review the situation..."
Oh, but it gets better: UHC REFUSED to refund the more than $9000 that the family had paid in premiums for the time they were cancelled!
I stopped selling major medical health insurance in 2007 for the simple reason that nearly every single major medical company is a den of thieves. They pay the CEOs millions, and sometimes BILLIONS of dollars in pay and benefits and cry "regulations" are keeping them from profitability (yeah, right).
They can do what ever they want to the customer AND the agent, and there's not a damn thing that can be done about it. Example: I sold a large group package in 2007 and I was owed $15,000 in commission. I was FIRED the next month for LACK OF PRODUCTION!
I had had sales every month I worked for them. But by firing me, they got to keep my $15,000. When the customer complained that they wanted me to be their agent, the company told them that I had QUIT the company.
As far as I'm concerned any time a maj med company takes it in the a$$, I'm smiling. I am not for government meddling in private enterprise, but I can see why so many people were bucking for a single payer system.
Twins were born in May. Wife goes to first dr. office visit after birth, and was told she didn't have insurance. Goes home, calls company, and was told they were dropped since they did not inform the company the family grew by two memebers! Every time I had a kid the insurance company knew right away I had a new member, since they were paying the damn medical bills!
That's not all: they cancelled the family retroactively to February! It was a difficult pregnancy so the family now owes $500,000 in medical bills.
They end up filing bankruptcy, losing their home, and moving in with mom and dad. After the story got picked up by NPR and a couple of other news outlets, UHC said, "...they would review the situation..."
Oh, but it gets better: UHC REFUSED to refund the more than $9000 that the family had paid in premiums for the time they were cancelled!
I stopped selling major medical health insurance in 2007 for the simple reason that nearly every single major medical company is a den of thieves. They pay the CEOs millions, and sometimes BILLIONS of dollars in pay and benefits and cry "regulations" are keeping them from profitability (yeah, right).
They can do what ever they want to the customer AND the agent, and there's not a damn thing that can be done about it. Example: I sold a large group package in 2007 and I was owed $15,000 in commission. I was FIRED the next month for LACK OF PRODUCTION!
I had had sales every month I worked for them. But by firing me, they got to keep my $15,000. When the customer complained that they wanted me to be their agent, the company told them that I had QUIT the company.
As far as I'm concerned any time a maj med company takes it in the a$$, I'm smiling. I am not for government meddling in private enterprise, but I can see why so many people were bucking for a single payer system.
- 3,344
Michigan Agent: There has GOT TO BE MORE on that story especially if NPR is covering the story. Does anybody believe NPR propaganda anymore? Just saying.
- 14,809
Planning on gaming the system is a very dangerous game. In this story, it could have had a tragic end. The boy could have been hospitalized for an emergency seizure. Then, they could have run off and applied for coverage but it would not cover any previous claims.
The parents could have been stuck with a huge medical bill and as we all know, going BK is not simple any more. If assets are available you have to pay.
It's a game I would never play.
The parents could have been stuck with a huge medical bill and as we all know, going BK is not simple any more. If assets are available you have to pay.
It's a game I would never play.
- Staff
- #10
Similar threads
