I recently encountered a problem with a PITA prospect and wondered if others have had this issue. Husband & wife, early 60's. Nothing serious but multiple chronic ailments.
I took a detailed medical history, then submitted to a handful of carriers for pre-screen. The recommendation was to consider two different carriers with leanings toward the carrier that would place exclusion riders but offer a premium about $400 less per month than the carrier that would cover the pre-ex but with a rate up.
The prospect did everything he could to derail the application, including asking another agent to submit an application to carrier #2 for review.
My application was submitted about a week after the other agent submitted. Both carriers wanted APS'.
My carrier had 1 APS; the other carrier (other agent) had 4.
Unfortunately, both carriers wanted an APS from "Dr Jones". Both carriers work thru EMSI for their APS.
Dr Jones received a request from carrier #2 via EMSI and sent the records. When my carrier submitted their request it was ignored as a duplicate.
This delayed things by 3 weeks with the client claiming the doc had sent the records, EMSI showing they had not received them, and my carrier doing nothing until the APS was received.
The doc told the prospect they sent the records out on 12/26. They also told EMSI they returned the check for the records since "payment was received so late".
My carrier received the returned check in the mail on 1/3 and promptly contacted EMSI. They instructed EMSI to contact the doc again and make payment by credit card which was done on 1/3.
The doc is still maintaining records were sent on 12/26 . . . over a week in advance of receiving payment.
Records were finally received by my carrier on 1/16 and reviewed.
The prospects wife was declined coverage.
Why?
She has several minor ailments, including one that almost never requires medication. She & her husband are "pill happy" and freely abuse the plan they have now (COBRA) which runs them over $1000 per month.
Her condition (MVP) cannot be detected by stethoscope and was only discovered during a very expensive ultrafast CT scan. It was prompted by her complaint of a single heart flutter.
I have several clients with MVP. None are on meds. None have even been ridered, rated or declined.
The issue here is this.
The pill happy folks created their own situation by abusing their medical plan and going to the doc for the slightest irregularity then asking for tests & meds to treat some rather common ailments. Not only did they want meds, but the latest (non-formulary) meds which are the most expensive.
After I completed the application online, but before it was submitted, the prospect went back & re-entered extraneous information in the application, noting EVERY doc visit in the last 5 years.
I am sure the underwriters had a stroke over that.
By submitting multiple apps simultaneously with different agents he delayed a decision by almost a month.
Actually, I am glad he is not going to be my client. I am not sure I could take much more of him.
The second I found out they went through another agent to fill out an app for another company I would have immediately called my company and took the app out of underwriting. I would have then called the client and told them to go through that agent for everything - and have a nice day.
The second I found out they went through another agent to fill out an app for another company I would have immediately called my company and took the app out of underwriting. I would have then called the client and told them to go through that agent for everything - and have a nice day.
John,
I understand that response and can identify reasoning from my mind of inexperience, but why would you handle it this way instead of trying to get the business. Is it the effort vs the odds of writing? The relationship isn't what it should be? The expectation that they'd drop for another in the near future anyway? Please provide insight.
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"Refried confusion is a-makin' itself clear" Dr. John
I'm independent and can represent all carriers. The fact that they would have chosen another agent and put in another app with a carrier I write with just means the client is pitting me against another agent ie; the client has no faith in me and doesn't trust my advice. Therefore that client can find another agent.
I considered telling the prospect to kiss off, but then I did not feel it was professional to do so.
Even though the prospect was a real pain to deal with (constant questions, refusal to accept my advice and quit "diddling" with the app, playing one against the other) I felt a responsibility to show them I was better than the other agent.
I knew going in their chances of getting a plan were slim because of the over-utilization of their current plan, but by the time I had taken the app I already had a lot invested in the situation. I figured I might as well ride it out.
Had I known early on that this individual was going to continue to shop and meddle with things, I would have walked away.
I know some folks will submit mulitple apps to see which carrier offers the "best deal". When an agent submits multiple apps you run the risk of delaying everything, such as what happened here.
I also feel it makes an agent appear to be less confident in their ability to assist the client when the pitch is, lets throw it out to the world and see what happens.
Somarco,
Would you be kind enough to clarify a few things for me please?
I recently encountered a problem with a PITA prospect and wondered if others have had this issue. Husband & wife, early 60's. Nothing serious but multiple chronic ailments.
>>>>>What is PITA?
The prospect did everything he could to derail the application, including asking another agent to submit an application to carrier #2 for review.
My application was submitted about a week after the other agent submitted. Both carriers wanted APS'.
>>>>Did you ask the prospective client if he or she was using another agent? If you did ask, did you explain the pros/cons of submitting multiple applications to numerous carriers w/out having a knowledgeable agent who understand the underwriting process?
The prospects wife was declined coverage.
Why?
She has several minor ailments, including one that almost never requires medication. She & her husband are "pill happy" and freely abuse the plan they have now (COBRA) which runs them over $1000 per month.
>>>>>Did you explain how the claim's review process works so both of them understood the process, and discuss alternatives for people who want to save money, but you use an excessive amount of medication?
Even though they are treating the symptoms and not the cause (i.e., genetics, lack of exercise and/or diet habits), there is a lot of research I found out recently about the pros/cons of alternative solutions (.e., treat the cause and not the symptom). Unfortunately, we live in a society that is fixated on the "give me a pill," to cure my condition, which w/out alternative methods (i.e., therapy, dieting, environment, exercise, etc.) Here is a a link that discusses MVP is futile. A client may not be interested, but at least they have some knowledge that they didn't before. An interesting link I found regarding MVP can be found here http://www.wright.edu/nursing/practice/mvp/default.htm
The pill happy folks created their own situation by abusing their medical plan and going to the doc for the slightest irregularity then asking for tests & meds to treat some rather common ailments. Not only did they want meds, but the latest (non-formulary) meds which are the most expensive.
>>>>I agree, see above comment.
After I completed the application online, but before it was submitted, the prospect went back & re-entered extraneous information in the application, noting EVERY doc visit in the last 5 years.
>>>>>Did you go over the application with them online or just transfer information from your notes and/or a paper application to the online form and submit it for their approval?
I am sorry to hear that you went through this, however, this type of information is great for new agents like myself. Thank you for sharing this experience with all of us.
-J.R.
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[COLOR=#000066]"Tell me and I will forget. Show me and I will remember. Involve me and I will understand." Confucius
A nickname given to me by an underwriter several years ago.
Pain In The Ass.
I find it useful to describe others as well.
Did you ask the prospective client if he or she was using another agent? If you did ask, did you explain the pros/cons of submitting multiple applications to numerous carriers w/out having a knowledgeable agent who understand the underwriting process?
Actually I knew the prospect was talking to another agent. Every time I answered his question I asked if the other agent was able to answer his question.
Sometimes the answer was yes. Other times he was non-committal. I told him I would interpret that as a no response.
I also talked about some of the dangers of submitting multiple apps, with one or more agents. I must confess I did not anticipate, or cover, the likelihood the doc would be so stupid and screw things up even worse than they already were.
Did you explain how the claim's review process works so both of them understood the process, and discuss alternatives for people who want to save money, but you use an excessive amount of medication?
There was considerable discussion about this, long before ever taking the app. The dialogue went on for several weeks before he finally agreed to move forward.
I discussed the advantages to having a lower priced plan that did not include copays, and would not allow his meds to accrue toward the deductible. I also gave him several sites to review the cost of meds for his "spread sheet" and suggested he speak with his doc about using lower cost meds, or even eliminating some that may be extraneous.
He was resistant at first, holding on to his belief that he could find a plan with a low deductible & copays that would be more cost effective than his COBRA coverage.
Eventually he reconciled to the fact he would not be able to dictate to carriers what he would get and the price he would pay.
Big time PITA.
I appreciate the link, but at this point I really dont care. This guy was a computer analyst and felt he had the answers to everything. He told me he only used the top doctors in their field. When his regular physician was unable to find anything wrong with his wife, a cause for the flutter, he took her to a top cardio guy in Atlanta. Doc Cardio could find nothing in a routine exam, so they asked him to do further testing. The ultrafast CT was the only test that found the MVP.
Most reasonable folks would have given up long before that.
Not this guy.
I am convinced the doc order the script to placate him and get him out of his office.
When I told them the MVP was creating issues in underwriting, he went back to the cardio for a consult. Doc told him if you were to put the entire population under a CT scan, probably 75% would show some evidence of MVP.
This created even more bravado for PITA as he insisted the carriers did not know what they were doing by asking for so much information on a common ailment.
As I said, by this time I had too much invested.
Did you go over the application with them online or just transfer information from your notes and/or a paper application to the online form and submit it for their approval?
I require all clients to fax a signed, paper app to me for review. This goes in their permanent file along with my notes. I then take the infromation from the app and transfer it to an e-app which is completed 80% of the way. It then goes to them to review, fill in the payment info, and submit to the carrier.
By the time PITA had completed the app he had already tampered with it by adding in details that did not help his cause. When I got back to reviewing it it was too late. He had already hit the submit button.
All this in spite of my comments that there was too much detail on benign issues that was going to turn a 4 page app into a 9 page epistle.
Of course he did not listen and the underwriter must have crapped in his pants when he opened the app.
There is not much different I would do if this comes up again. The only thing is to issue a warning about submitting multiple apps, especially where it seems like an APS may be ordered.
I discussed this issue with the company rep and he agreed, this was unusual, but he also said he can understand why it might happen.
Did you ask the prospective client if he or she was using another agent? If you did ask, did you explain the pros/cons of submitting multiple applications to numerous carriers w/out having a knowledgeable agent who understand the underwriting process?
Actually I knew the prospect was talking to another agent. Every time I answered his question I asked if the other agent was able to answer his question.
Sometimes the answer was yes. Other times he was non-committal. I told him I would interpret that as a no response.
I commend you for continuing your work with the clients. I would have taken John's approach.
I also talked about some of the dangers of submitting multiple apps, with one or more agents. I must confess I did not anticipate, or cover, the likelihood the doc would be so stupid and screw things up even worse than they already were.
Live and learn. From what you say, it appears you went above and beyond. As for the doctor, now you know I would be interested to find out how the other agent approached the client.
I discussed the advantages to having a lower priced plan that did not include copays, and would not allow his meds to accrue toward the deductible. I also gave him several sites to review the cost of meds for his "spread sheet" and suggested he speak with his doc about using lower cost meds, or even eliminating some that may be extraneous.
Very smart of you.
He was resistant at first, holding on to his belief that he could find a plan with a low deductible & copays that would be more cost effective than his COBRA coverage.
I encountered a client who expressed similar thoughts. I lost that discussion. Some people "need" to be right! NEXT!!!!
Eventually he reconciled to the fact he would not be able to dictate to carriers what he would get and the price he would pay.
That is what I love about this industry. Probably one of the reasons rebating is illegal and unethical.
I appreciate the link, but at this point I really dont care. This guy was a computer analyst and felt he had the answers to everything. He told me he only used the top doctors in their field. When his regular physician was unable to find anything wrong with his wife, a cause for the flutter, he took her to a top cardio guy in Atlanta. Doc Cardio could find nothing in a routine exam, so they asked him to do further testing. The ultrafast CT was the only test that found the MVP.
You are apparently very patient.
Most reasonable folks would have given up long before that. Not this guy.
I like to joke around with my clients, but also convey the importance of "valuing your time." Sure you can spend the hundreds of hours that a successful agent has completed to become proficient in understanding the plethora of health insurance plans, but the real question is, If you find an agent you trust and who is knowledeable, why would you?
I normally compare shoping for insurance, cars, etc. to grocery shopping and using coupons in the following example. A bit similar to John's credit card shopping analogy.
Sam wants to go grocery shopping and expects to pay around $200 if he goes to Frank's Grocery or Giant. However, with the coupons he has, he will save $10 going to Giant. If Frank's Grocery store is 5 miles away and Giant is 10 miles away (city traffic by the way), which grocery store would you visit? 9 X's out of 10, the individual will say Giant because they want to save money. A-HA, but are you saving money? NO!!!! Factor in the extra gas and driving time and "your" free time and it "may not" be worth the time.
I average 1 1/2 hours (shopping time) on a monthly basis when I visit the grocery stores, excluding driving time and unloading the products (another 30ish mins.). That equates to 1 1/2 hours a month (1 normal evening) or 1/3 of weekend day (try shopping on the weekend for a full months supply and see how long it takes). At $20 an hour that equates to $30 of my free time wasted. $30 + $2.50 (one gallon of gas @ 15 m/p/g) + $10 (1/2 hour driving time to and from the grocery store) = $42.50 for a $10 savings. They may not agree with you, but at least they will recognize that their free time is valuable and that is a healthy outlook on life. This example works really well with men because most men dislike shopping.
This created even more bravado for PITA as he insisted the carriers did not know what they were doing by asking for so much information on a common ailment.
Welcome to the dirty words in insurance, "loss of profit."
All this in spite of my comments that there was too much detail on benign issues that was going to turn a 4 page app into a 9 page epistle.
Would you be able to provide an example of a benign issue? I am thinking something as trivial as a sore throat that is merely the effect of a cold. Are we on the same page?
Every time someone dicks me around like that, or refuses to take my calls and respond to my emails after we put in a lot of work, I send them a form letter in the mail, addressed to the spouse, about how insurance agents are people too, and in all my years, I have never encountered someone with less common decency then they.... It is a pretty harsh letter, and I probably send out two of them a month. It doesn't pay the bills, but it makes me feel much better! About 20% call or email an apology, and twice, I got their business.
I had a similar situation the other day. I arrived to a clients house where we sat down and went over all his options for about an hour. We decided to go with an HSA through World opposed to the other options. As we are filling out the application his wife says, "what about the app we submitted online yesterday with Blue Cross." HUH???? I asked them who helped them and they said no one. I asked them if they wanted to finish the app and use me as their personal broker, they said yes! I made them sign an agent of record form which makes me the broker on the books for that app. One way or another I'm getting them as a client. Some people just don't know better I guess!
As a footnote, more for clarification than anything, when I was taking the app for my carrier he mentioned that he had already submitted the app through the other agent and gave me the option to either wait & see what Time offered or drop out of the running. At that point our discussions had run off & on for almost 2 months with numerous emails back & forth and phone calls.
I still felt I had the upper hand, so I told him I was moving forward. I dont give up easily, especially when I think I have the upper hand.
I opted to move forward, so I can't complain, and that was not the purpose of my post. It was mostly to inform others of what can happen when multiple apps are submitted simultaneously and an APS is ordered.
Blue is different in GA. Once an app is submitted they will not recognize an agent of record unless you have (can't recall the exact figures) something like 200 - 300 individual cases on the books (I don't and never will) or have written at least 100 cases with them in the last 12 months.
Has anyone run into a situation where multiple apps were submitted simultaneously, either by one agent or two agents and an APS was not ordered. If so, what was the outcome? Thanks.
I try to stay away from multiple apps but I have indeed put in multiple apps a few times. It normally involves a case where the underwriting decision isn't clear.
I can put an app into Aetna and Assurant at the same time and as long as an APS isn't ordered I simply review both decisions.
This is nothing you want to get into a habit of doing. First off all, you're technically not allowed to to it per your insurance company. Secondly, there's a cost to underwriting and you're wasting their time. Thirdly, you have placement percentages to hit with companies like Assurant. I'm in their TCP and I need an 80% placement percentage. I can't hit that if I'm just throwing in apps to see who's got the better offer. Use pre-screen.
I just put in an app for a family who's son has mild seasonal asthma. Carrier #1 came back with a 1 year waiver.
I spoke with the client and they decided they would prefer to have it covered and pay more. So I'm figuring Aetna or Blue Cross which will most likely rate them up.
I really don't like submitting multiple apps but in this scenario I kind of have to.
Asthma is something I wont mess with in a rider situation unless there are no other choices. In GA I would suggest Aetna or KP. Both will cover without exclusion as long as the individual is accepted by underwriting.
Blue wont cover the condition for at least 12 months, possibly longer and still rate up the policy by 20%.
We all get caught in that trap every now and then. If I have a prospect who is not forthcoming, or seems to be a know it all, I move on. There are too many other people waiting to obtain my services.
Analytical people will "analyze to paralyze".
I had a woman who wanted me to shop around for LTC for her, using the companies that were listed on Consumer Report's top 10 list. Since it was a referral, I played along, wound up losing the sale to an out of town rep, who didn't know what he was doing.
She stopped returning my phone calls, when it came time to fill out the app. And it was only after she was declined did she call me back. I told her there was nothing I could do for her. Sorry.
The more beligerent they are, the more they have to hide.
Multiple applications
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