Insurance Agent Forum

[cadylou]

I have a gal who is 41, has high blood pressure as a side effect of birth control pill, high cholesterol, and had some counseling & was prescribed celexa for depression in 2004. She's no longer under treatment for depression.

Coventry declined her - BCBS would be auto decline due to counseling for depression, Humana would also decline & I have a prescreen going for Assurant, but am not sure what will come back there.

Does anyone know of a company that would take her? Aetna doesn't operate in KS yet.

I can write Golden Rule & World, but never do - so I'm not familiar with their underwriting.

Any help would be appreciated. She's going to be VERY unhappy when I relay this good news, so I'd like to have all my bases covered.

Thanks.

[healthagent]

First of all, why would you submit her to Coventry without knowing the outcome? They don't have any underwriting guidelines or pre-screen?

GR will most likely decline. If not she'd be signing riders for a week. Assurant "MIGHT" take her but you're looking at a 50% rate up just to start the bidding.

If you email me more details I'll call my underwriter and give you a definite answer. Height and weight will come into play.

[cadylou]

When she & I talked about her health, she never disclosed the cholesterol.

Coventry would have taken her with the just depression meds & HBP. She did the app online through my link, so I never saw it prior to submission. If I'd known about the combo chol/HBP - I would not have submitted to them. I've had people declined just for that with no other problems. They don't like the combo at all.

I'll send you a direct e-mail with some details. If you can find anything out for me, that would be greatly appreciated.

[healthagent]

No problem. That's why I never have clients fill out their own app.

[somarco]

Unless they operate differently in KS from GA, Coventry does not offer a pre-screen. They use a debit system based on medical condition + meds and accept/decline without riders.

Some carriers say 3 conditions and you are out. Others say 3 meds for one condition is a strike out. A few consider hypertension & hyperlipidemia to be a co-morbidity issue, especially if she is overweight and/or a smoker.

Just based on what you have posted, I see no reason for a decline. Must be more to the story.

[newmindfashion]

Cadylou,
With all due respect for my comrades here, in my opinion, Golden Rule will likely put a rider on outpatient mental health costs.

She has a chance to get in without a rider on cholesterol if she selects a deductble of at least $2500. No upfront copay plans or else the cholesterol will get ridered also. In short, no outpatient mental health and possible no rider on cholesterol if a high deductible is selected.

[somarco]

Jesse -

GR will probably put a rider on the HBP, chol & psych.

Their "standard" approach is 3 riders = decline. This has been my experience and I almost never use their copay plans. Everything is $2500+ on the deductible.

[newmindfashion]

Bob,
GR may be doing things differently here than in Georgia. In CT, if someone takes a ded. of 2500 + then cholesterol and BP are not ridered usually. Nor are certain other maintenance conditions with a high deductible. Hypertension is ridered in the form of a $400 additional deductible on lower deductible plans. I've even had depression and anxiety not ridered on 2850/5650 ded. HSAs.


Jesse

[somarco]

That's odd. That has not been my experience here.

I certainly cannot explain the difference in underwriting from state to state.

[healthagent]

Underwriting from state to state is drastically different. No only do state DOIs have completely different guidlelines to follow but each state's profit margin will dictate how heavy/easy underwriting is. In CT they DOI has a very strange set of underwriting guidelines. In CT riders are not allowed so GR "tries" not to rider there, but they still do. No other carrier offers riders except GR in CT. Odd.

[newmindfashion]

Bob,
They've actually pitched this to me verbally over the phone. They must have a good loss ratio in CT. Would they really underwrite so differently in each state?