Even though I have been at this for a while I would like to sharpen or confirm my understanding of what carriers actually are able to "look-up" on a client as part of underwriting.
Obviously, they see whatever comes up on an APS and MVR and MIB.
I am a little hazy on what the MIB has. Prescriptions show up etc. But what else. Do they have visibility to all claims against health insurance polices and the nature of the treatment. How does that work. A guy goes in to see a doc and has had a cough or had a chest pain but never got a script of any further treatment. Does that show or are they dependent on a script to see that?
What else do they see?
Thanks for any comments
Winter
------------------------------------ The Bolsheviks are dining in the capital.
Re: What does Big Brother actually look at?Go to Top
Originally Posted by Winter
Even though I have been at this for a while I would like to sharpen or confirm my understanding of what carriers actually are able to "look-up" on a client as part of underwriting.
Obviously, they see whatever comes up on an APS and MVR and MIB.
I am a little hazy on what the MIB has. Prescriptions show up etc. But what else. Do they have visibility to all claims against health insurance polices and the nature of the treatment. How does that work. A guy goes in to see a doc and has had a cough or had a chest pain but never got a script of any further treatment. Does that show or are they dependent on a script to see that?
What else do they see?
Thanks for any comments
Winter
The MIB does not have prescriptions listed. Companies can do a "scrip" check for that to see what a person is being prescribed.
The MIB is an insurance company filing system. They list all bills paid by them into the system for other insurance companies to access. If a person had a procedure and paid cash, it will not be in the MIB.
The scrip check is the same. I just had a client this week that told me he takes Coreg for his heart. That is a drug that made it a modified plan. That's what I wrote it as. It's a company that requires a phone interview at point of sale and during the phone interview, they run the MIB and a scrip check. When the client gave the phone back to me to record the number, the interviewer told me that his scrip check showed that he was on no meds. I asked the guy about it and he said his doctor gives him samples of the Coreg and he hasn't ever actually purchased any.
The MIB also shows that you have applied for insurance. It does not show if you still have that policy or if you were declined or rated.
It's helpful to pull an MIB check on yourself. It's been a couple of years since I did it, so, I don't remember the details of how I did it. I made contact via the web and had to fill out some forms and such. Anyway, it's a help to see what kind of info they collect.
I have one company that relies on the scrip check more than the MIB. We have found many instances of the prescription info being wrong. We have usually been able to get it corrected. I've been on conference calls with other agents saying that they also had wrong info come back on the scrip checks.
Re: What does Big Brother actually look at?Go to Top
Originally Posted by jdeasy
The MIB does not have prescriptions listed. Companies can do a "scrip" check for that to see what a person is being prescribed.
The MIB is an insurance company filing system. They list all bills paid by them into the system for other insurance companies to access. If a person had a procedure and paid cash, it will not be in the MIB.
The scrip check is the same. I just had a client this week that told me he takes Coreg for his heart. That is a drug that made it a modified plan. That's what I wrote it as. It's a company that requires a phone interview at point of sale and during the phone interview, they run the MIB and a scrip check. When the client gave the phone back to me to record the number, the interviewer told me that his scrip check showed that he was on no meds. I asked the guy about it and he said his doctor gives him samples of the Coreg and he hasn't ever actually purchased any.
The MIB also shows that you have applied for insurance. It does not show if you still have that policy or if you were declined or rated.
It's helpful to pull an MIB check on yourself. It's been a couple of years since I did it, so, I don't remember the details of how I did it. I made contact via the web and had to fill out some forms and such. Anyway, it's a help to see what kind of info they collect.
I have one company that relies on the scrip check more than the MIB. We have found many instances of the prescription info being wrong. We have usually been able to get it corrected. I've been on conference calls with other agents saying that they also had wrong info come back on the scrip checks.
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Originally Posted by Winter
Excellent. Thanks. What do you call the database or system where they do the script check?
Winter
I don't know how to access the scrip check. Maybe an insurance company would tell you if it's available to the public. The times I've had troubles with it has been when a person was declined or rated because of a med and we found that the person was not, nor ever had, taking that medicine. I had to get Dr. statements that they person was not on that med and the company took care of it from there.
I tried to find a scrip check on the web and didn't have any luck.
Re: What does Big Brother actually look at?Go to Top
As indicated above, MIB has records based on benefits paid by carriers. They do not have benefit records on items paid in cash . . .
MIB has information based on a proprietary coding system. Seems like the use something like 400 codes vs the 10,000 or so that are in ICD-9 coding used by carriers and claims administrators.
MIB does in fact have information in their system about life and health applications that were declined. I had a client a few years ago applying for health. The carrier made a check and found he had an MIB "hit" indicating an earlier application for life insurance had been rejected. He applied as a non-smoker. Lab work proved otherwise. The carrier rejected his application (but later issued it at higher, standard rates). That hit kicked out his application to GR as well.
They countered with a tobacco rate and he refused.
I guess lawyers don't like being accused of lying . . .
Milliman Intelliscript is one of the companies used by carriers. There are a few others but I don't recall who at this time.
Like MIB, Intelliscript has records of prescribed and filled meds filed with a carrier but does not have samples distributed by docs.
Re: What does Big Brother actually look at?Go to Top
Originally Posted by somarco
As indicated above, MIB has records based on benefits paid by carriers. They do not have benefit records on items paid in cash . . .
MIB has information based on a proprietary coding system. Seems like the use something like 400 codes vs the 10,000 or so that are in ICD-9 coding used by carriers and claims administrators.
MIB does in fact have information in their system about life and health applications that were declined. I had a client a few years ago applying for health. The carrier made a check and found he had an MIB "hit" indicating an earlier application for life insurance had been rejected. He applied as a non-smoker. Lab work proved otherwise. The carrier rejected his application (but later issued it at higher, standard rates). That hit kicked out his application to GR as well.
They countered with a tobacco rate and he refused.
I guess lawyers don't like being accused of lying . . .
Milliman Intelliscript is one of the companies used by carriers. There are a few others but I don't recall who at this time.
Like MIB, Intelliscript has records of prescribed and filled meds filed with a carrier but does not have samples distributed by docs.
MIB will not tell an insurance comapny that a policy was declined or aproved, for that matter. Now, they may have a way of letting a comapny know off the radar.
If a person applied for a policy and does not have it now, the comapny knows it was either declined, not taken or dropped. They will want to know why.
Pull your own MIB and you will see that they do not put on there whether a policy was approved or not. Insurance companies do use term "hit". So, there is some way of their knowing that there was something amiss on an application.
I've had "hits" before and the company will have me re ask a question to see what the outcome was for that situation.
What does Big Brother actually look at?
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