Case Study...

Mar 25, 2007

  1. Mike_Golden1
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    Mike_Golden1 Guest

    In the interest of making all of us better agents I am presenting this case for discussion. Please, no personal criticisms or attacks, OK?

    Last Monday I was visiting a Life Insurance client and was asked about Health Insurance for their 19 year old daughter, a college student. I asked about health issues, was told everything was fine except for situational depression being treated with Wellbutrin (10 mg, 1X daily) so wrote an application for an Assurant SaveRight HSA (which doesn't provide benefits for Anxiety/Depression treatment so it doesn't get rated up). She is only seeing a therapist quarterly, last visit in January. The premium, including the 5,000 AME, is $102 a month.

    Imagine my surprise when Assurant called the client for a telephone interview and had her tell them she had been diagnosed with BiPolar disorder, which, of course, is an outright decline.

    I just checked the application and we had listed the condition as Depression. It is possible that the client changed it to Bipolar disorder when she verified the health information but I can't look that up.

    I'm not concerned about losing the sale but have always considered myself fairly perceptive about whether someone is not telling me the whole truth. Is there something that pops up in anyone's head that would trigger something of concern to dig deeper here or is it just another of those cases where you get surprised in the end?
     
  2. Dave020
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    Dave020 Super Moderator Moderator

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    Did the carrier obtain medical records on the applicant? If so, then it may be what the doctor put in the patient's record. If not, then perhaps the applicant said something during the phone interview.

    Underwriting is a fun time when APS are requested and there are things in the records not known to the patient.

    I remember one time Dr. Dean (Edell) was on his showing discussing this exact issue and mentioned that doctors used to have a code TTFO for certain troublesome patients. TTFO - Told To F**k Off! They actually would put that in the medical records.

    Dave
    www.davefluker.com
     
    Dave020, Mar 25, 2007
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  3. Crabcake Johnny
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    Crabcake Johnny Guru

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    Sounds like just a case where you get suprised at the end. Also sounds like a typical case of some people "down-playing" their actual health condition.

    I had a decline a few months ago after a phone interview. Lady said she got occasional migrane headaches and was on medication. I dug deeper and that's all she disclosed. After the phone interview a day later is was declined. I called and HIPAA was waived in my face since the client disclosed more on the phone about her condition then she disclosed to me.

    Upon calling the client she finally coughed up that she had a brain stem disorder that caused horrible headaches and would probably need brain surgery in the future.

    I also had a case where the child was ADD - 8 years old. The mother simply said it was simply attention deficit - one med. After phone interview the son was declined. Turned out the son was in therapy 5 days a week, taking three medications and was diagnosed with three mental conditions.

    Are these cases where people blatantly lie? Maybe...maybe not. I don't think a lot of people like to confront their actual health status.
     
  4. MrStan
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    MrStan Expert

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    Again, I am new at this - but my opinion is it can go two ways... Some people do blatantly lie about their health - but others (and I know this from family experience) really enjoy having "issues". So lets say my Uncle Tom feels very depressed - he goes to his Dr. Everything checks out and he's put on Wellbutrin - but it's not helping - so he does some research - self diagnoses and comes up with BiPolar. So now he is convinced that he's bipolar - and that gives his feelings some validilty. He may be the kind of person actually excited to tell people this - so he feels some sort of normalcy. The "see I am not a lunatic - I am BiPolar" condition.

    This is just my take on some people - and like I said - It's like a disease in some circles - my family included - I fight hard to stay immunue. lol.
     
    MrStan, Mar 25, 2007
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  5. Mike_Golden1
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    Mike_Golden1 Guest

    No medical records were requested. It's possible that something popped up on MIB, they requested a phone interview, and the client might have confirmed the diagnosis.
     
  6. natem2112
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    natem2112 Super Genius

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    Mike_Golden1,

    This is an excellent post, these are the types of situations that newer agents need to be aware about.

    Prep your clients and prequalify when in doubt.

    I still get peeved when I find some prospect lying about their health conditions, then when you actually are try to get them through underwriting, HIPPA gets slammed in your face, thanks you very much bureaucracy!
     
  7. Mike_Golden1
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    Mike_Golden1 Guest

    Sometimes I get the feeling that clients think that if they fool you they will fool the insurance company. I always tell clients that it is better to put everything on the application than for the insurance company to find out later-sometimes that works, sometimes it doesn't. I've had several clients tell me that they don't smoke even though they do-they are always told that it doesn't do them any good to lie because, if they make a claim and the insurance company finds out they are smokers and can relate the claim to the smoking the policy will be rescinded and no coverage will apply. I can't protect anyone, however, who will not admit to something at all.
     
  8. somarco
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    somarco That Medicare Guy

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    Try Aetna
     
    somarco, Mar 25, 2007
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  9. salpro22
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    salpro22 Guru

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    Very true. That type of behavior allows an individual to place the blame elsewhere.

    I would talk w/ Uncle Tom about the dangers of self diagnosing any mental condition. I would also emphasize that the majority of professionals who are able to diagnose use strenuous guidelines when reaching a decision.

    I would advise Uncle Tom to take some responsbility and talk with a therapist, and a psychiatrist as a back-up. It is amazing what exercise, goal setting and support from family and friends can do for somebody.
     
    salpro22, Mar 25, 2007
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  10. Mike_Golden1
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    Mike_Golden1 Guest

    Nate,

    Exactly, I've actually had a potential client for life insurance complain that I 'wasn't being agressive enough' in quoting him rates and that it was hurting me in his eyes. The guy was 52, Type 2 diabetic, and had a Heart Catheterization that showed a 30% blockage. I prescreened him with 3 different Underwriters, came back with a Table 4-6 best possible offer, and he believed the rate was too high.

    I made it a point not to call him back after that meeting, any application put in for him was destined for the Decline bin.

    I am becoming much more selective on who I work with, it's one of the benefits of generating lots of leads and having more people to call than possible in a day. Give me the honest, mostly health people anyday as clients, the rest of the world can have the rest.
     
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