Metabolic Syndrome

somarco · 06-22-2009, 07:38 AM

Humana is no different from any other carrier engaging in post-issue underwriting. They will request doctors records depending on diagnosis when a claim is submitted.

I have probably half a dozen going on now. Half involve significant claims (xs of $100k) and the others are minor. The most recent one involved an anxiety med prescribed but never filled following one doctor visit.

The guy was stressed over some issues at work, went to see his doc. Doc gave him a sample of Xanax and wrote a script which was never filled.

That was a year ago.

More recently he went to the doc for a checkup. H1 requested records and discovered the anxiety issue. Since the med was never filled it did not show up on the Rx history.

The situation was within the lookback period so they sent him an amendment to sign, increasing the premium $12 per month retroactive to the eff date.

He asked my advice. I told him to sign it and move on.

He did and we did.

Blue & Coventry are notorious for post-issue underwriting. I understand Time is as well but since I haven't written anything with them in 2 yrs I wouldn't know.

The only ones (so far) that haven't been as diligent in conducting post issue underwriting are GR and Aetna.

I have a 4 yr track record with GR and no issues. My time for writing with Aetna is really a little more than a year so I can't say. Only issue so far with Aetna was requesting a letter of creditable coverage. We provided it, they paid the claim, end of story.

dgoldenz · 06-22-2009, 09:38 AM

I just got the underwriting info back on a case this morning. Person told me she had pancreatitis in January, fully resolved. Turns out she had that, plus three other conditions that weren't mentioned. Good thing she told me about all this up front.....at least she's HIPAA eligible.

somarco · 06-22-2009, 10:21 AM

Sometimes they really don't know. Other times they are being evasive. They think if they don't tell the carrier will never find out.

Of course we all get the ones who don't have high blood pressure any more. Their medication keeps it in check so they are perfectly healthy.

I take a lot of time explaining the underwriting process. If they still want to lie, that is their problem.

The truth usually comes out when I tell them the carrier will look at their Rx history and conduct a recorded phone interview.

ins.dave · 06-22-2009, 01:14 PM

Re: Metabolic Syndrome Go to Top

Humana is no different from any other carrier engaging in post-issue underwriting. They will request doctor’s records depending on diagnosis when a claim is submitted.

I was referring to pre approval. I agree on post.

I have probably half a dozen going on now. Half involve significant claims (xs of $100k) and the others are minor. The most recent one involved an anxiety med prescribed but never filled following one doctor visit.

The guy was stressed over some issues at work, went to see his doc. Doc gave him a sample of Xanax and wrote a script which was never filled.

That was a year ago.

More recently he went to the doc for a checkup. H1 requested records and discovered the anxiety issue. Since the med was never filled it did not show up on the Rx history.

The situation was within the lookback period so they sent him an amendment to sign, increasing the premium $12 per month retroactive to the eff date.

He asked my advice. I told him to sign it and move on.

He did and we did.

They should all be that reasonable. Many are.

Blue & Coventry are notorious for post-issue underwriting. I understand Time is as well but since I haven't written anything with them in 2 yrs I wouldn't know.

The only ones (so far) that haven't been as diligent in conducting post issue underwriting are GR and Aetna.

Well, I did have a heart condition claim denied.
Somehow this girl got it past them prior to approval. 17 days later she went in for heart surgery. I remember GR wanted to see er records …

I have a 4 yr track record with GR and no issues. My time for writing with Aetna is really a little more than a year so I can't say. Only issue so far with Aetna was requesting a letter of creditable coverage. We provided it, they paid the claim, end of story.

Aetna has come in handy because, although more expensive typically, they have a slightly more lenient uw. Have had numerous people approved who were declined by others. Keep an eye on your commission money, as you should do with all companies anyway. P.S. I did receive 1st year com. on that re rate deal. Also on her hub. The re rate issue complicated processing.

* please note bold type