Claim Denied & Policy Rescinded

[axeman462]

Doesn't happen often, but every now and then a claim will get denied, and the policy rescinded because the insurance company "obtained additional information from a health care provider....serious health condition denied on app..."
In this case it is with Medico, and their HIP plan for the dead husband of a client of mine.
Never real sure how to have this conversation with the customer. Any advice before I call her?

 

[saintstigers]

Doesn't happen often, but every now and then a claim will get denied, and the policy rescinded because the insurance company "obtained additional information from a health care provider....serious health condition denied on app..." In this case it is with Medico, and their HIP plan for the dead husband of a client of mine. Never real sure how to have this conversation with the customer. Any advice before I call her?

wouldn't the carrier pull all the MIB and Rx history prior to issuing?

 

[axeman462]

wouldn't the carrier pull all the MIB and Rx history prior to issuing?

I believe all Medico does for their HIP is MIB. Apparently that wasn't enough to find whatever they just found

 

[somarco]

Be her advocate. Approach this as a good cop to the carrier's bad cop.

Mrs. Brown, those ba$tards at Snake Firm want's to screw you out of money you are entitled to. They will pull any trick in the book, including accusing your husband of lying. I am so embarrassed they would take advantage of a poor widow like yourself. Let's get the SOB's. By the way, the mortician did such a good job of reconstructing your husband's face after he took a header off the Third National Bank building. They really do good work.

Or, you might consider a slightly toned down approach.


Mrs. Brown, I hate to tell you but the insurance carrier has denied the claim. I want to help you as much as I can, so will you be willing to review the application and see if there is anything odd? Maybe a health condition your husband forgot to disclose?

 

[DS4]

Or, "Mrs Brown, your dead husband is a lying bastard". "And, because of him, I will no longer receive a commission on the policy".

 

[smokin goose]

Or, "Mrs Brown, your dead husband is a lying bastard". "And, because of him, I will no longer receive a commission on the policy".

That's the one I'd go with.

 

[sshafran]

Or, "Mrs Brown, your dead husband is a lying bastard". "And, because of him, I will no longer receive a commission on the policy".

Don't forget to ask for referrals!

 

[LGilmore]

What you hope is that he filled out the app, not you. Learned this a long time ago in the business. Takes away the "we told the agent and he/she marked it wrong."

Good luck, hope it doesn't come back to bite you. Make sure all your files are in good order.

 

[refiman1]

Be her advocate. Approach this as a good cop to the carrier's bad cop.

Mrs. Brown, those ba at Snake Firm want's to screw you out of money you are entitled to. They will pull any trick in the book, including accusing your husband of lying. I am so embarrassed they would take advantage of a poor widow like yourself. Let's get the SOB's. By the way, the mortician did such a good job of reconstructing your husband's face after he took a header off the Third National Bank building. They really do good work.

Or, you might consider a slightly toned down approach.


Mrs. Brown, I hate to tell you but the insurance carrier has denied the claim. I want to help you as much as I can, so will you be willing to review the application and see if there is anything odd? Maybe a health condition your husband forgot to disclose?

I am definitely leaning toward your latter approach vs the former. My 2c