I know for a fact isosorbide is a ko. Carvedilol may not be like you said for HBP. CHF is a ko. I know they have been busy updating the new agent portal FTW!
A Question Regarding Script Checks.
- Thread starter Jerard
- Start date
I know for a fact isosorbide is a ko. Carvedilol may not be like you said for HBP. CHF is a ko. I know they have been busy updating the new agent portal FTW!
Script/Pharma checks aren't like MIB, we don't share with each other on that front. As others have pointed out, these checks can leave some holes- in theory you could have a type II diabetic with bipolar disorder running around and it not be reported if they paid cash or went to a non-reporting pharmacy.
The only things scripts tell you is the med, dose, and who gave it. Which can be a vital clue; say some provider gives a client Lamictal. If it's a psychologist I'm thinking your client is bipolar. If it's a neurologist they're more likely to be epileptic.
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How reliable is MIB. What I mean is our Aetna rep said they believe MIB only catches about 30% of health conditions. Meaning, if the client were to lie and say no to a question they have a good chance of sliding by.
I assumed this would be true as long as the client hadn't ever answered yes to the condition on another app
What if they take it anally?
Indiana in reality if a client had cancer 3-5 yrs ago and never took any drugs and never answered yes to any health questions he'd never show up on the mib. Now if he applied for insurance in the last 7 yrs and an insurer picked up a certain bad drug he would probably put it in an mib code. Is that correct uw? Now what if an insurer pulled an aps and the client cancelled the app befor an underwriting decision came and the aps had bad stuff in it? Because the app had negative info in it but the app was cancelled before any decision was made would the company still report it to the mib?
If they've never applied anywhere, obviously zero. It's a smoke signal for everyone; I personally wouldn't believe the 30% ratio but it depends on the LOB you're in. Mostly because MIB is the basis to get the records/report that confirm the issue the reported issue. So in the end MIB was just a stepping stone to another information source; not the final source.
I'm posting something sometime soon here or in the life section (I know, heaven forbid they ever come here for anything) on MIB/Rx Scans/APS's, basically all the underwriting issues that make you want to rip our teeth out.
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If you saw the history you're supposed to report it; even if they decided to go not taken during underwriting. They actually have codes for "specifics unknown" which let everyone else know there's something here but we don't know or didn't get records to figure out what it was or if you believe it rises to the level of "coding attention".
But it is down to the carrier and the underwriter to get their job done; sometimes people get forgetful or lazy and just don't code/report. Lord knows I work with some of those people.
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Carriers utilizing an Rx check for underwriting use either Milliman Intelliscript or Optum who collect data from Pharmacy Benefit Managers on prescription drug purchases and maintained for 5 years. PBMs are third party administrators (TPAs) primarily responsible for processing and paying prescription drug claims.
They also build networks of retail pharmacies, develop and maintain formularies (approved lists of drugs for reimbursement), negotiate discounts, and developed electronic prescribing technology. Such PBMs include ExpressScripts, CVS Caremark, Health Information Designs, ICORE Healthcare, and lots of captive PBMs such as Wellpoint, Aetna, Cigna. Today, more than 210 million Americans nationwide receive drug benefits administered by PBMs.
When a person fills a prescription at any of the PBMs, they are able to track who the doctor is (and therefore what his/her specialty is), the drugs and dosages the doctor has prescribed for any reason, whether or not the person filled the prescription, and whether or not it was refilled. Carriers subscribing to Intelliscipt and/or Optum can figure out what the diagnosis is, or at least a close proximation, and therefore whether the applicant has (or had) an acute problem (one that will go away) or a chronic problem (which will either recur on occasion, or affect the applicant for the rest of their life.) From the data, carriers can also determine if an applicant has comorbidities such as diabetes and heart disease.
Final Expense carriers have told me Intelliscript reveals information on 65% to 70% of applicants while those carriers utilizing both Intelliscript and Optum obtain Rx info on over 90% of applicants. Using both helps a carrier properly place an applicant with the appropriate plan of coverage, will greatly improve Mortality Actual-to-Expected ratios, and reduce rescissions. Bottom line... this helps a carrier turn a profit.
For agents, an Rx check helps field underwriting by identifying liars or those applicants who are not aware of their diagnosis or forgot about an Rx prior to issue. This, in turn, reduces rescissions, agent chargebacks and agent E&O claims. Carriers not using an Rx check will eventually raise rates, lower compensation, tighten underwriting on the app or get out of the market as most of us have seen over the years.
They also build networks of retail pharmacies, develop and maintain formularies (approved lists of drugs for reimbursement), negotiate discounts, and developed electronic prescribing technology. Such PBMs include ExpressScripts, CVS Caremark, Health Information Designs, ICORE Healthcare, and lots of captive PBMs such as Wellpoint, Aetna, Cigna. Today, more than 210 million Americans nationwide receive drug benefits administered by PBMs.
When a person fills a prescription at any of the PBMs, they are able to track who the doctor is (and therefore what his/her specialty is), the drugs and dosages the doctor has prescribed for any reason, whether or not the person filled the prescription, and whether or not it was refilled. Carriers subscribing to Intelliscipt and/or Optum can figure out what the diagnosis is, or at least a close proximation, and therefore whether the applicant has (or had) an acute problem (one that will go away) or a chronic problem (which will either recur on occasion, or affect the applicant for the rest of their life.) From the data, carriers can also determine if an applicant has comorbidities such as diabetes and heart disease.
Final Expense carriers have told me Intelliscript reveals information on 65% to 70% of applicants while those carriers utilizing both Intelliscript and Optum obtain Rx info on over 90% of applicants. Using both helps a carrier properly place an applicant with the appropriate plan of coverage, will greatly improve Mortality Actual-to-Expected ratios, and reduce rescissions. Bottom line... this helps a carrier turn a profit.
For agents, an Rx check helps field underwriting by identifying liars or those applicants who are not aware of their diagnosis or forgot about an Rx prior to issue. This, in turn, reduces rescissions, agent chargebacks and agent E&O claims. Carriers not using an Rx check will eventually raise rates, lower compensation, tighten underwriting on the app or get out of the market as most of us have seen over the years.
Yep...did an interview today for FBL and the only medication the client was taking besides Metformin and Glipizide for type II diabetes was Isosorbide and she was declined after the interview. They really need to update their RX list!! Put her with TA and we'll see what happens. Should be ok as she's been taking it for over 2 years.
