Question for Golden Rule Experts Out There

bill3173 · 03-16-2009, 04:02 PM

A prospective client came to me for health insurance as a referral for an Assurant Health Policy.

I don't use them much anymore except for the referrals the company sends me, and referrals that ask about/for them etc.

This lady went thru hell with them, only to be turned down for being pre-diabetic, and some other "undisclosed" conditions.

She called me today, to let me know that she got approved by GR. That really knocked me back. I seldom use them because of their extraordinary use of riders and rate ups and declines, but she said that she got approved with no riders and no rate up.

I'm happy for her, but how is this possible after being KO'd by Assurant?

Any thoughts?

somarco · 03-16-2009, 04:15 PM

Pre-diabetic is not a condition. Kind of like pre-pregnant.

Either you are or you are not.

If you are taking Metformin or something similar to control blood sugar, you are diabetic. If your doc told you to lose weight, exercise and cut out the sweets or else you were going to BE diabetic, that is different.

Pre-diabetic, pre-hypertensive, etc are just a warning, not a diagnosis.

So either she did not understand what she has, or she lied.

Sometimes folks get smarter the second or third time they apply. I have had this happen a few times. They apply through me, get declined, then call back later to say they got approved with Aetna.

I know they lied.

souldeux · 03-16-2009, 04:27 PM

Well, Assurant does have a weird thing they do with "pre-diabetics." Copying and pasting from the latest newsletter:

__________________________________________________ ___

Major Medical Insurance for Pre-diabetes or Non-insulin -dependent Diabetes

Major Medical Insurance for Individuals with

Pre-diabetes or Non-insulin-dependent Diabetes

If you have early symptoms or a diagnosis of diabetes and are not yet eligible for Medicare, you may qualify for individual major medical insurance from

If You're :

Pre-diabetic or a non- insulin-dependent diabetic
Age 60-63
A non-smoker and
Without diabetic - related health complications
You don't have to compromise your quality of care.

Individual major medical insurance could be just an application away !

The Assurant Health Advantage Assurant Health offers flexible, quality coverage, along with several savings programs and features to help you control your health insurance costs.

Choice of health plans - including a Health Savings Account (HSA)
Personal access to registered nurses to help manage your health
Up to $25 million medical coverage
2- or 3- year premium rate guarantee options
Prescription drug coverage
Get the health coverage you need - and deserve - from Assurant Health !

Coverage is available to individuals in: AK, AL, AR, CO, IL, IN, KS, KY, MD, MI, MO, MS, MT, ND, NE, NM, OK, PA, SC, TX,

WI and WY. Product options vary based on the plan selected. Not all options are available in all states. All premiums

Include a rating. Applicants are individually underwritten and some individuals may not qualify. Available plans include

MaxPlan

SM Elite, CoreMedSM Elite, and OneDeductible Elite plans with $2,000 and higher deductibles.
See the insurance contract for a complete listing of plan benefits, limitations, and exclusions.

Assurant Health is the brand name for products underwritten and issued by Time Insurance Company.

J-65298 (1/2009) © 2009 Assurant, Inc. All rights reserved.
__________________________________________________ ___

Now, I have no damn clue what pre-diabetic means...
- - - - - - - - - - - - - - - - - -
You know, after re-reading the first two posts, I have no idea why I felt compelled to share any of that. You're right, Bob. The number of conditions an applicant has, in my experience, decreases in proportion to the number of applications they've filled out.

healthagent · 03-16-2009, 05:30 PM

If Assurant declined and GR approved with no adverse UW action chances are she lied to GR.

somarco · 03-16-2009, 05:38 PM

The number of conditions an applicant has, in my experience, decreases in proportion to the number of applications they've filled out.

Perhaps Benny Hinn paid them a visit . . .

bill3173 · 03-16-2009, 05:50 PM

Originally Posted by healthagent

If Assurant declined and GR approved with no adverse UW action chances are she lied to GR.

I know that you are a GR expert from way back, and I'm glad that you weighed in on the discussion.

Don't they check the MIB? I know very little about their uw. I've only used them for STM and very sparingly over the last few years.

I tried them out for IM policies years ago, and really didn't care for their plans or pricing, so it was hard to get behind them, guess I may have to re-think it now.

somarco · 03-16-2009, 05:53 PM

GR uses the app, phone interview, MIB and Intelliscripts.

Couple of options.

She lied and got away with it.

She applied before the adverse info hit MIB or Intelliscripts . . . and she lied.

bluemarlin08 · 03-16-2009, 06:04 PM

Pre diabetes is known as Metabolic Syndrome, typically patient has HBP, Chol and Trig elevation and overweight. I seriously doubt any company is going to take a risk with this issue without holding out info.

bill3173 · 03-16-2009, 06:26 PM

Originally Posted by somarco

GR uses the app, phone interview, MIB and Intelliscripts.

Couple of options.

She lied and got away with it.

She applied before the adverse info hit MIB or Intelliscripts . . . and she lied.

She couldn't get approved on the KeyMed after we tried for a Max Plan. The carrier ordered records from more than one doctor, after I begged them to find a way to approve her.

I pre-screened her with AMS, and they told me to **** and fall back in it.

Do you think in this case, she is going to get her policy rescinded down the road?

We placed her in a hospital indemnity plan, which was better than not having anything, and she's asked me to cancel it.

Really, I've done all I can at this point, but I know the road to policy rescinsions is paved with people who thought they were in the clear.

somarco · 03-16-2009, 06:39 PM

Wash your hand & walk away. Something fishy here and you don't want any part of it. Tell her you can't cancel her KeyMed policy, but give her the number to call.

FWIW, some carriers will allow agents to call in changes to a policy but I never do it. Contractual changes, adding/deleting dependents, changes in coverage and terminating coverage is something between the policyholder and carrier. Never, ever get in the middle of that one.

bill3173 · 03-16-2009, 07:02 PM

Originally Posted by somarco

Wash your hand & walk away. Something fishy here and you don't want any part of it. Tell her you can't cancel her KeyMed policy, but give her the number to call.

FWIW, some carriers will allow agents to call in changes to a policy but I never do it. Contractual changes, adding/deleting dependents, changes in coverage and terminating coverage is something between the policyholder and carrier. Never, ever get in the middle of that one.

She didn't get the keymed, that's my concern. I have her in a dinky donuts hospital plan with a local carrier you've never heard of, underwritten by me and my brother. She didn't get KeyMed, but got approved by GR?? Well, thanks for your input.

Assurant is the only carrier that I have that allows agents to make changes to the policy, and I do that sparingly. I've told clients before that they had to do it, and when they ask Assurant, they tell them straight up that agents can make changes. It looks like you're lying, but of course you're right, better them than you.

somarco · 03-16-2009, 08:26 PM

She didn't get the keymed

My bad.

I shouldn't be reading your post while listening to my wife go on and on and on . . .

chp · 03-16-2009, 09:03 PM

In my market, I sell a lot of G.R. She lied on her application, period. If she was declined by Assurant, and especially the key med plan, yet approved by GR, she lied.

If she makes a claim, she will be refunded her premiums, and her claim will not be paid.

SportsNut · 03-16-2009, 09:05 PM

Originally Posted by somarco

My bad.

I shouldn't be reading your post while listening to my wife go on and on and on . . .

That is correct. If you wish to stay "happily" married, you should devote 100% of your attention toward your wife, as she goes on and on and on.... it just works better that way.

If you don't blieve me, just ask her... she'll tell ya.

somarco · 03-17-2009, 07:13 AM

Quite a few carriers are doing post-issue underwriting. The first time you see a doc, even for a physical, they request records. Any variance in doc records and your app re-opens your file.

healthagent · 03-17-2009, 09:46 AM

Everyone fears universal health care as the end to our careers. No, the end of our careers is when all medical records are digitized and carriers have online access.

Then under-trained underwriters who don't have the faintest clue on how to interprete them will decline, rider, and rate-increase us all out of business.

It will also expose all those little trips to the doctor clients don't talk about and don't pop on the MIB. Remember the trip to the doc for shortness of breath 3 months ago and the doc said "just come back if it happens again? Decline.

Take every client you signed up last year and say the carrier got a chance to review their medical records before approval? Take a stab on the decreased percentage of placement.

bill3173 · 03-17-2009, 11:47 AM

Originally Posted by healthagent

Everyone fears universal health care as the end to our careers. No, the end of our careers is when all medical records are digitized and carriers have online access.

Then under-trained underwriters who don't have the faintest clue on how to interprete them will decline, rider, and rate-increase us all out of business.

It will also expose all those little trips to the doctor clients don't talk about and don't pop on the MIB. Remember the trip to the doc for shortness of breath 3 months ago and the doc said "just come back if it happens again? Decline.

Take every client you signed up last year and say the carrier got a chance to review their medical records before approval? Take a stab on the decreased percentage of placement.

I would like to take a stab at it, but really don't know what to expect. My current placement first pass with all health carriers, and I use 5 consistently, is 70%, but I don't know if that is going to hold up in the current enviornment.

If they are having trouble interpreting records now, what will happen when they have greater access, and more obscure comments made by Doctors that they can't read or understand.

I am appealing a case right now for a young doctor in love that was declined over a few comments he made about a condition that he thought he had years ago, but doesn't. It was confirmed by a battery of tests that he doesn't have this condition.

Now we're going thru the arduous task of appealing and they are making his life miserable all because he thought he could be friendly and talk about things loosely on the phone with them, after I told him that they are challenged and to keep his guard up. Well..that's enough, I'm holding back.

healthagent · 03-17-2009, 12:08 PM

Take my wife - went to see a doc about a back problem which we disclosed on the app. During the visit however the doc recommended that she take meds which she declined.

A script was never written. The doctor simply suggested that one option was medication. She chose to go to the chiro instead.

Now, I've never seen her medical records but if that doc put in the notes: "medication prescribed but declined by patient" that could have triggered a decline or at best a thorough grilling by the UW dep't.

Now we'd be left to fight with the carrier that no prescription was ever written.

Trust me, you've never see a clusterf***k until underwriters get access to everyone's medical records.

somarco · 03-17-2009, 04:11 PM

In spite of what Obamaman speaks, don't expect EHR to happen any time soon, if ever. EHR has been discussed for at least 15 years. Too many obstacles.

Paradigm · 03-17-2009, 04:42 PM

Yeah most likely privacy problems. Imagine it being outsourced to Choicepoint out in Alpharetta, a government contractor that crunches all kinds of consumer data for profile of consumer behavior. Add in health records and you now have an even greater Big Brother issue.

For Example

"Our records show that you did not have your annual visual accuity examination and as a result your priviledge to operate a motor vehicle has been revoked. If you fail to remedy this situation with 10 days your vehicle will be confiscated under section D1 of the Citizen Protection Act."