Claim Denied & Policy Rescinded

Nov 17, 2015

  1. axeman462
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    axeman462 Guru

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    Doesn't happen often, but every now and then a claim will get denied, and the policy rescinded because the insurance company "obtained additional information from a health care provider....serious health condition denied on app..."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?
     
  2. saintstigers
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    wouldn't the carrier pull all the MIB and Rx history prior to issuing?
     
  3. axeman462
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    I believe all Medico does for their HIP is MIB. Apparently that wasn't enough to find whatever they just found
     
  4. somarco
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    somarco GA Medicare Expert

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    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?
     
    somarco, Nov 17, 2015
    #4
  5. DS4
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    Or, "Mrs Brown, your dead husband is a lying bastard". "And, because of him, I will no longer receive a commission on the policy".
     
    DS4, Nov 17, 2015
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  6. smokin goose
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    That's the one I'd go with.
     
  7. sshafran
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    Don't forget to ask for referrals! :yes:
     
    sshafran, Nov 19, 2015
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  8. LGilmore
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    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.
     
    LGilmore, Nov 19, 2015
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  9. refiman1
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    I am definitely leaning toward your latter approach vs the former. My 2c :nah:
     
    refiman1, Nov 19, 2015
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