Age 69 Male LTC Decline; Recommendations?

CALTCAgent

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Hello,

I had a 69 year old male declined for LTC.

The reason stated on decline letter was "history of kidney disease, multiple knee surgeries and stomach ulcer and office visits in august & november, were most significant in our decision".

Knees: He has had both knees replaced, because old football injuries. The last one just over 3 months ago. Physical therapy done. Walks fine, no assistance devices.

Stomach Ulcer: Cauterized in 2008. No more surgeries scheduled or complications. Takes Protonix.

Kidney Disease: He said he went to Dr. in August and they found abnormal reading on test regarding kidney. He went back in November and they said his kidney was fine. He feels he does not have kidney disease.

Today he told me he got a letter from Dr. saying no kidney disease. I had recommended he get this as I thought that was the "main" reason he was declined.

He tells me he takes:

1. Nortriptyline-help sleep (does this help with sleep?, or is this one possibly for more than that?)
2. Protonix-stomach ulcer
3. Atenolol-HBP

I called the underwriter from the company and they wouldn't tell me much and said it was "too sensitive" in nature. At first I was thinking that a letter saying "no kidney disease" would be enough for re-consideration. The underwriter tells me they will not re-consider even with the letter and its too sensitive to tell me anything.

Sould I:

A. Try with another company as this company might be being "too picky" and just overall not want this case.

b. Get a letter with more details sent to the client, even though that might take more time and not reveal anything?

c. Any other thoughts, ideas?

Thanks!
 
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Read through the company's field underwriting guide--some companies automatically decline multiple joint replacements. I would also look up the original kidney diagnosis in the UW guide.

Is this a situation where an annuity with a ltc benefit would be appropriate?
 
I believe that Never_a_Dull_Moment on this forum claims to shop all the carriers and have special relationships with underwriters...I believe he will split cases with people....Now this is my recollection, I might have the wrong person and I have never dealt with him myself.
 
Read through the company's field underwriting guide--some companies automatically decline multiple joint replacements. I would also look up the original kidney diagnosis in the UW guide.

Is this a situation where an annuity with a ltc benefit would be appropriate?

He feels they are wrong with the kidney disease and still wants to try for traditional LTC. What makes this hard is that they won't share the "secret" info in the medical records, so I can't tell if he is really all out of options.

As far as the splitting of business I really feel I'm capable of shopping the carriers myself and keeping the full commission. I know "NADM" is very knowledgeable however. Its whats unknown in the APS that is making this difficult. Hard to shop what you don't know.

Thanks!
 
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He feels they are wrong with the kidney disease and still wants to try for traditional LTC. What makes this hard is that they won't share the "secret" info in the medical records, so I can't tell if he is really all out of options.

As far as the splitting of business I really feel I'm capable of shopping the carriers myself and keeping the full commission. I know "NADM" is very knowledgeable however.

Thanks!

Have your guy go to the kidney doctor and pick up a copy of his records. He has that right.
 
Have your guy go to the kidney doctor and pick up a copy of his records. He has that right.

Thats probably a good idea. I have never actually looked at an APS, are they understandable to the non medically trained person such as myself or him?

Thanks!
 
norway is right.. if- never a dull moment-, doesn't jump in . send him a e mail. he will be able to tell you , what can be done. he has a website on hard to place LTC. good luck
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what company denied him?
 
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Thats probably a good idea. I have never actually looked at an APS, are they understandable to the non medically trained person such as myself or him?

Thanks!

Have you not told the client to request the reasons from the company directly. If they will not talk to you about the issues, it means that he was likely declined for reasons not disclosed on the application. You are likely stuck as there is more wrong with the guy than he told you. Have the client get the info from the carrier, or have them send the info to his doctor. Scott can not help you if you do not really know what is wrong with the person.

Else, it sounds like your client may be in denial about something.
 
A lot of companies have a disclosure of protected medical information that your client can sign to have underwriting disclose this information. If not, your client can often request the information on why the underwriting decision was made the way it was.

Also, there should be MIB codes logged that you should be able to get a hold of (going to cost money though).

The insurance company can't hold all this information from both of you (you and client) at least your client needs to have an explanation (if requested) why he can't get coverage.

Keep in mind medical insurance underwriting and the practice of medicine can, at times, have nothing to do with one another. Where someone appears healthy in the eyes of the practice of medicine can still cause nervousness with an insurance company. LTC doesn't really have a sub-standard risk category, but sometimes underwriting practices are different, so a decline with one may not be a decline with another. Like life and DI though, a decline increases the chances of another elsewhere.
 
Since the decline was based on a review of medical records, the client's doctor has a right to contact the insurance company and request specific information why his patient was declined. If the doctor disagrees with the company's reasons, he/she can contest their decision and file an appeal.

Two knee replacements by itself is not a reason for a decline unless the cause was Rheumatoid arthritis. For osteoarthritis, some companies want a 6 month wait after PT has been completed.
Ulcers by itself should also not be a reason for a decline unless the reason for the ulcers was due to alcoholism or excessive drinking.
Nortriptyline is used to treat depression.
Very rarely are underwriters wrong in their decisions and it's even rarer for an appeal to result in a reversal. My guess is there's a lot more going on with this guy that you think.

Start with the applicant sending a copy of the decline letter to his doctor and have the doctor send a letter to the carrier. The company may not share their reasons with the applicant or the agent, but they will address the doctor.
Good luck.
 
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