Texas Agents Help Me Out....

dgoldenz · 05-11-2009, 04:36 PM

I have a client who had hydocephalus as a child at 3 weeks old and had a shunt put in his head - hasn't had any issues with it since (he's now 35 years old). Last year he had a CT scan that showed the shunt had moved, but a report from his specialist stating that the shunt is not currently doing anything to help him and there would be no ill effects of it moving. Can someone tell me if this would be an auto-decline with the major Texas carriers (and more specifically, BCBS of TX). I'm putting in pre-screens with Humana and Aetna, but know UHC would either decline or exclude and want to find out what BCBSTX might do. Any help is appreciated, thanks.

TXINSURANCE · 05-11-2009, 04:42 PM

I can't imagine any IFP carrier will accept him, but you never know.

Why can't he keep the insurance he has now? When was he insured last? If the above is NO and LONG TIME, then he gets group or risk pool.

dgoldenz · 05-11-2009, 04:43 PM

He has insurance through a group right now but is paying $900/month for the family and wants to reduce cost if possible. Humana HSA $5k deductible plan is $400/month, but I'm pretty sure even if they offered coverage they would exclude the hydrocephalus and any complications of the shunt. Thanks for your input.

*STIBROKER@AUSTIN.RR.COM* · 05-11-2009, 05:19 PM

Aetna.....hell put in a app with the top 4.....you might be surprised....they just approved a pot smoking client of mine...at a 50% ...he also had a few other things going on also....

moonlightandmargaritas · 05-11-2009, 05:21 PM

Originally Posted by STIBROKER@AUSTIN.RR.COM

they just approved a pot smoking client of mine...at a 50%

You guys burn one while doin' the app?

dgoldenz · 05-11-2009, 05:21 PM

I looked at some of the Aetna plans on ehealth but it seems for a decent plan with a 50% rate up he'd be near what he's paying now with significantly less benefits. His current plan is $0 deductible/no coinsurance/$12 copay/$15 Rx. He'd probably only change it if there was a decent plan in the $350-500/month range post-underwriting.

SunDevil · 05-12-2009, 01:50 AM

Is the client the employee? If so, maybe you could place the other family members on ind. plans. I would first break down the costs on the group plan. I would think that the larger part of the 900.00 is on the additional family members.

dgoldenz · 05-12-2009, 07:52 AM

Originally Posted by SunDevil

Is the client the employee? If so, maybe you could place the other family members on ind. plans. I would first break down the costs on the group plan. I would think that the larger part of the 900.00 is on the additional family members.

Not a bad idea....I'll have to look into that option. Thanks for the suggestion.

*STIBROKER@AUSTIN.RR.COM* · 05-12-2009, 08:54 AM

You know I don't meet my clients anymore.....

Originally Posted by moonlightandmargaritas

You guys burn one while doin' the app?

souldeux · 05-12-2009, 10:28 AM

Assurant considers brain shunts on a case-by-case basis. Humana, GR, World, and Imerica are autodeclines. Not sure about Aetna.

Edit: In Georgia, in one of my cases (shunt was in 32 years ago on a 40 year old woman).

dgoldenz · 05-12-2009, 10:39 AM

Aetna declined....is Assurant even competitive in TX?

TXINSURANCE · 05-12-2009, 11:13 AM

Aetna declined....is Assurant even competitive in TX?

No - it is a joke in Texas.

This client needs to stay on group, they are not a good fit for the individual market unfortunately.

They can keep the group and wait about 6 months until ObamaCare passes and re apply.