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Originally Posted by healthagent Gov't stepping in isn't necessarily a bad thing. Let's take a look at the late 1800's to the early 1900's and ...


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Old 02-24-2008, 02:56 PM   #21
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Originally Posted by healthagent View Post
Gov't stepping in isn't necessarily a bad thing. Let's take a look at the late 1800's to the early 1900's and look at how private companies operated without any regulation.

The gov't stepped into private industry with minimum wage and labor laws. If not, then people would be working for $1.50 an hour for 60 hour weeks.

Although not direct analogies to what we're discussing my point is just because the gov't steps in doesn't make it a bad thing.
This analogy is good, but who decides what the definition of "good" "fair" and "bad" should be. I'm all for personal responsibility and agree with everything said thus far.

I would also go as far as to say that when we have access to medical records (I cannot figure out why this hasn't happened yet) people who lie or try to commit insurance fraud should have that listed on their MIB or a similar record. This means that ALL insurance carries report to the MIB and people are held responsible for their actions.
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Old 02-24-2008, 02:58 PM   #22
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Originally Posted by healthagent View Post
Read up on Walmart;

Work off the clock or you're fired. Ohhh...that's illegal? When then take what you're making from $6.25 an hour and go sue us.

Happened to me and I lost a job over it. When I was a teenager I worked for Color Tile basically doing whatever they needed me to do. After my shift one day I had punched out - my manager then tells me he needs some help but it has to be off the clock - throws "team work" and "loyality" in my face.

I said no and left. Guess what my schedule looked like the following week?

However, in those case I "could" have sued. Imagine no regulation.
Yes, but normally the people who go above and beyond have a better chance of going further than those who clock out at exactly 5pm when the shift ends.
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Old 02-24-2008, 03:08 PM   #23
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Originally Posted by salpro22 View Post
I would also go as far as to say that when we have access to medical records (I cannot figure out why this hasn't happened yet) people who lie or try to commit insurance fraud should have that listed on their MIB or a similar record. This means that ALL insurance carries report to the MIB and people are held responsible for their actions.
JR, most of this is being done now.

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Old 02-24-2008, 03:23 PM   #24
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5 years max in my opinion should be the look back
So take on strokes, MI and any cancers? If it happens, look for rates to jump significantly and possibly fewer carriers in the market.

No more rescinds,
Rescissions are uncommon except in the most blatant situations. They get a lot of press but reality is, it almost never happens.
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Old 02-24-2008, 03:45 PM   #25
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Rescissions are uncommon except in the most blatant situations. They get a lot of press but reality is, it almost never happens.
Most carriers in my market are rescinding 1 to 2% annually. Multiply that by 1,000,000 policies or more and you have a sticky situation.
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Old 02-24-2008, 05:01 PM   #26
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Most carriers in my market are rescinding 1 to 2% annually.
And your source is?

How many of those were for fraud?
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Old 02-24-2008, 05:32 PM   #27
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I am no where near that - but yes I have had rescinds. You can do everything right and still have policies rescinded if the carrier wants to weasel out of the claim.
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Old 02-24-2008, 06:01 PM   #28
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policies rescinded if the carrier wants to weasel out of the claim.
They better have proof of fraud, and in almost every case they do.

In addition to being illegal, it is just plain stupid to rescind policies in a cavalier manner.

I have had one in the last 4 yrs. The lady filed a fraudulent application, KP rescinded.
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Old 02-24-2008, 07:53 PM   #29
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Originally Posted by moonlightandmargaritas View Post
JR, most of this is being done now.

Click here for more info.
Thanks Paul, the key word being "most." I should have been clearer.

There needs to be a central company that tracks things, such as, previous insurance, medications, declines, rate-ups, etc.
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Old 02-24-2008, 08:03 PM   #30
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There needs to be a central company that tracks things, such as, previous insurance, medications, declines, rate-ups, etc.
Some of that info is available to participating carrierss from MIB. There is at least one company (can't recall the name) who tracks prescribed meds for the last 5 years. Carriers like Humana & Aetna check MIB and (the Rx source) and compare results against your app to see if you lied or not.
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Old 02-24-2008, 08:44 PM   #31
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I have had policies rescinded for complete BS reasons. It depends a lot on the carrier. For example one rescind the guy goes to get Blood Pressure RX 1.5 years into the policy. Carrier pulls records and finds 5 or 6 years ago a doctors note for slightly elevated reading. The guy claims he was stuck in traffic and running late for his docs appointment. One reading was slightly elevated, then the next were fine - all other readings were fine since then as well. He never had any blood pressure RX or other history.

The question on the application read ... "ever" had high blood pressure, and he answered no.

My point here is usually the client is full of BS - I happened to know this guy personally so it holds more weight. They refunded 1.5 years of premium which was enough to cover his RX for a year (and then some) and I put him on a another carrier and enjoyed a $800+ charge back - that was great.

A lot of companies have installed new computer programs to catch and track common first year claims. Carriers will jump through hoops to prove pre ex on claims over an undisclosed dollar amount. This is all tracked back to the original underwriter, who is scored on usage of approved applications as well.

There is a lot going on most people are unaware - it is called underwriting, and that is the game at the moment.
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Old 02-24-2008, 08:54 PM   #32
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Who is the agent for this HealthNet account?
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Old 02-24-2008, 09:12 PM   #33
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Hopefully Ehealth... lol
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Old 02-24-2008, 09:32 PM   #34
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Assuming it's the case that was in the newspaper (LA Times?), then it was not Ehealth, it was a private agent. A private agent who apparently took it upon himself to fill out the application for this client (supposedly).

I wonder what percentage of recissions are on applications filled out by the agent vs those filled out by the subscriber?

That could be a telling stat. In this case she claims she was busy doing hair while he took the application and was not focused on the questions he was asking.

I suspect soon the carriers will add a section onto the application that specifically requires both signatures as to who filled it out.

In this case it is really sad because the subscriber already had a health insurance policy with another carrier. So it looks like the agent did a policy switch and left off a few things (like she has cancer) from the application.

Kind of hard to hammer the carrier on this one.
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Old 02-24-2008, 09:55 PM   #35
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Originally Posted by Dave020 View Post
In this case it is really sad because the subscriber already had a health insurance policy with another carrier. So it looks like the agent did a policy switch and left off a few things (like she has cancer) from the application.
So the fallout from this....
...get rid of the damn agents!

I just wonder if this was a new agent who was too inexperienced to know better, or just a thief.

After seeing the stupid questions in meetings and elsewhere from agents who have been licensed for many years, I am not surprised at this type of thing. While this probably was an intentional act, how about all the errors because of "non-professional" licensed agents?

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Old 02-24-2008, 10:03 PM   #36
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Ultimately it comes down to the agents fault , of course.

Carriers want UNIVERSAL MANDATED HEALTH CARE, not a government plan - but a mandated plan. When something is mandated you don't need brokers.

Look at GI states and MA if you need some examples.

The carriers will win big time if we get some form of Universal Coverage, and the individual market will thrive - just not with your hands in the cookie jar.
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Old 02-24-2008, 10:04 PM   #37
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Originally Posted by GreenSky View Post
So the fallout from this....
...get rid of the damn agents!

I just wonder if this was a new agent who was too inexperienced to know better, or just a thief.

After seeing the stupid questions in meetings and elsewhere from agents who have been licensed for many years, I am not surprised at this type of thing. While this probably was an intentional act, how about all the errors because of "non-professional" licensed agents?

Rick
Better and worse I think. Better as carriers know that agents are a very inexpensive distribution channel for their products. Worse because most likely the fallout from this kind of thing is going to be mandatory in class or online training classes (with of course no CE) on how to sell their products...ugh!

I have not gone to one of those stupid meetings you refer to in several years for exactly that reason. I believe that unless you do health insurance full time, don't do it at all.

So looking forward to those two hour training classes...NOT!
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Old 02-24-2008, 10:22 PM   #38
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I agree with TX on this one - once we get mandated coverage we're out of a job - plain and simple. If any carrier threw out 5% commish consider it a gift.

It's not "if" but "when" we'll get mandated coverage. We'll never have gov't run universal health care - never. But an expanded version of what Mass. is doing is coming.
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Old 02-24-2008, 11:09 PM   #39
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Originally Posted by somarco View Post
Some of that info is available to participating carrierss from MIB. There is at least one company (can't recall the name) who tracks prescribed meds for the last 5 years. Carriers like Humana & Aetna check MIB and (the Rx source) and compare results against your app to see if you lied or not.
Quite true, but it's not universal.
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Old 02-24-2008, 11:13 PM   #40
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Originally Posted by somarco View Post
Some of that info is available to participating carrierss from MIB. There is at least one company (can't recall the name) who tracks prescribed meds for the last 5 years. Carriers like Humana & Aetna check MIB and (the Rx source) and compare results against your app to see if you lied or not.
Key word being participating.

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