Kids Health Insurance Cancelled Because of Ear Infections?Go to Top
I sent some Unicare quotes to a lead that was requesting quotes on her 2 children, one being 3 and the other 2 years old, and the lead called me and told me that Unicare just cancelled the plan that she had on them because of ear infections. They told her that the ear infections were pre existing and so Im guessing that maybe she didn't disclose that they had been seen before for ear infections and so cancelled her plan. If this is true can they do that? Thats crazy because I have 3 kids and kids get ear infections like several times a year. Its common!!
If anyone on the application has sought medical treatment/advice for anything in the past "X" years (depends on the carrier) is must be put on the app. Some carriers like Assurant will state that they don't care about single occurences of a cold of flu.
You don't know? You did not assist in completing the app? You don't have a copy of the app?
Its common!!
Carriers look for 2 things in medical history. Something that is chronic & potentially expensive to treat. Something that is serious and either ongoing or has potential to return and is expensive to treat.
You & your client apparently failed to take this into account when completing the app.
I still can't believe you don't have a copy, and did not assist in completing the app.
What lawmakers fail to realize is insurance companies don't have the resources to pull medical records from every doctor every patient has seen. Underwriting would take 6 months.
Also, the insurance companies need to be able to rescind a policy for people who have not yet sought treatment yet plan on burning the company. Imagine someone without insurance starts having severe back pain and is savvy enough to not see a doctor and instead just grab health insurance first.
You cannot have a system that rewards people for being good liars. I hear "Oh, I forgot about that emergency room trip" but that doesn't pan out with auto insurance - "Oh, I forgot about that DWI four years ago."
Yea UC will put a waiver on ear infections (thats the first question I ask when I have kids going on a application either by themselves or with parents)...tubes can run about $6,000 and if they find that the kid had ear infections and not on application they will get their money back and policy rescinded....have had this happen about twice in 10 years with UC.....oh...it was not for ear infections on my rescinds....time to take that one to Aetna...
I've had 5 policies rescinded since I've been independent and it's not pretty. It every case the client lied or "forgot" about a medical condition to me and the company. Heaven forbid your client has a policy rescinded, told you about a condition and your reply was "that doesn't need to go on the app."
How does a person who wants to be honest, get some form of health insurance for a child with pre-existing conditions then?
I had a similar situation with my son. UnitedHealthCare declined him due to a pre-existing condition. I appealed to the company and even asked if related illnesses could be excluded or if I could pay a higher premium - but to no avail.
My personal life experience has been that honesty is NOT rewarded, it is, in fact, often punished.
I agree we can't have a system that rewards liars, but we can't have a system that punishes the honest either.
You people seem to think having insurance is a right.....when in reality it is a privilege.....when it becomes a right then we will all have free govt. run health plans......hell I want a viper....but I don't qualify for it......
What does honestly have to do with this? You can be honest about the fact that you have brain cancer and an insurance company is supposed to take you? You can be honest that you've have 2 DWI's and three accidents and car insurance is supposed to take you? You can be honest and say you've have a recent heart attack and life insurance is supposed to take you? What if you're honest on an interview and say you got terminated from your last job for sexual harrassment? Is your honesty supposed to be rewarded by getting the job?
First of all, have you shopped around? UHC has brutal underwriting guidelines which is why they no longer get any of my business.
I didn't say the insurance comany is required to take me - or in this case, my son. I'm an underwriter (Aviation Insurance). I decline people for insurance all the time. I understand how the system works. But when an agent calls me back to negotiate, I have solutions for him/her. There is always a way to get insurance in aviation.
When I called the agents at Golden Rule about the declination, they blew me off and said "those are the underwriting rules." Thankfully, the underwriter send me a very nice letter explaining their position. I don't agree with their position, but at least the underwriter took the time to explain himself, which I respect.
I'm asking (again), how does somebody with a pre-existing condition get acceptable health care coverage (note: I did not say "good" or "cheap") without lying on an application?
If my son is injured in an accident, unrelated to his pre-existing condition, can I not get insurance to cover treatment of his injuries? If he contracts an illness, unrelated to his pre-existing condition, can I not get insurance to cover treatment of that illness?
This situation is what prompted me to start pursuing a career in health insurance. I need to find answers and I need to help other people in the same situation as me.
My son's life it too precious to me to accept "no" as an answer. I understand and respect what you folks are saying, but I refuse to accept it as the final answer. I believe that there is ALWAYS a better way to do things.
It really just depends on what your son's pre-existing condition is. Some companies may take him, others might decline. If no one will take him here are your choices:
1) Get a job that offers health benefits
2) Check to see if your state has a guatanteed issue plan
3) Become self-employed and write yourself a group plan. Many states have "group of one" plans.
I also have a son, five years old. His health would come before anything else in my life. If I had to shut down what I was doing just to get a job that provided health insurance I'd do that.
In my case MD requires a group of two. I'd hire my wife as an employee and write myself a group plan.
You don't know? You did not assist in completing the app? You don't have a copy of the app?
Its common!!
Carriers look for 2 things in medical history. Something that is chronic & potentially expensive to treat. Something that is serious and either ongoing or has potential to return and is expensive to treat.
You & your client apparently failed to take this into account when completing the app.
I still can't believe you don't have a copy, and did not assist in completing the app.
You have a tough road ahead in this business.
Read my post again Somarco? I sent her quotes with Unicare. She was just a lead that requested quotes. So I sent her a quote with Unicare first. She then called me after receiving the quotes from me and told me no she couldn't go with Unicare because they had had a Unicare plan and they already cancelled them because of the ear infections. :x I WAS NOT THE AGENT THAT WROTE THE PLAN WITH UNICARE. In fact I think she just went online and applied directly with them.
If companies are cancelling because of ear infections then that is BULLSHIT! I do not know a kid or kids that does not or has not had frequent ear infections. Its common when kids get a cold to have an ear infection also. I had them and my kids have them to!! Next thing you know they will be cancelling people for having the flu!!!! [color=red][/color]
You're mistaken - her policy got cancelled because she didn't put it on the app. Had she put it on the app most likely she would have still be accepted unless the ear infections were very frequent. Then it's up to the company to decide if they want to take the kids, rider them or decline. She never gave the company that choice since she didn't disclose it.
I have plent of people on policies where the kids have had ear infections. I'm normally off to Aetna since they don't rider however Assurant has been either doing CSDs on it or standard depending on the specifics.
And by the way, constant ear infections can lead to surgery which the insurance companies are not gonna want to cover if it's pre-ex.
I'm asking (again), how does somebody with a pre-existing condition get acceptable health care coverage (note: I did not say "good" or "cheap") without lying on an application?
It depends on the condition.
I have clients with waivers on incidental conditions and they are quite pleased. Others need (and want) full coverage and are willing to pay the extra premium to get the coverage they need.
Just this AM I spent almost an hour talking with a lady who had just bought her third discount plan the day before. They hit her card for $269 + a $100 application fee.
She has HBP, high cholesterol and mild depression. Meds run $170/month which is manageable for her. (They were over $500 before she asked her doc to rewrite generics and older meds when possible).
I gave her a choice of GR HSA with a $2850 SIR and waivers on the meds for $384 or the same plan with Time for over $650 per month.
She opted for the GR plan and she knows she will be responsible for her meds and they will not accrue toward the deductible.
She has no problem with that.
Neither do I.
My acceptance & placement rate is in the high 90's. I do my job up front so carriers don't have to waste their time on junk apps. My clients know up front what will be covered, what won't, and what will require an extra premium.
They also have a good idea if they even stand a chance of getting covered.
There is a reason why carriers provide agents with underwriting manuals. Most agents never bother to open them up.
Kids Health Insurance Cancelled Because of Ear Infections?
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