Ethics

Nov 17, 2007

  1. somarco
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    somarco That Medicare Expert Guy

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    I have client who applied for insurance and was accepted but with a perm rider for anything involving the colon, including exams, treatment of any illness of the colon, etc.

    He had a colonoscopy a year ago and had some benign polyps removed. The carrier asked for the path report and made their offer based on the report.

    He is scheduled to have a follow up colonoscopy next month. I asked if the carrier would issue the policy without the rider if the report was clear.

    They declined.

    When I pressed the issue they said the type of polyps had "a higher risk of developing cancer".

    My suggestion was to refuse the offer and keep what he has for now (even though the premium is going through the roof in January). I felt he would be better off with a fresh colonoscopy and another carrier.

    I have not told him why the carrier refused to remove the rider. While I don't always agree with underwriters assessments, and I have not seen the path report (nor am I a doc but I do have access to detailed medical guides) I feel there is a chance the underwriter is correct.

    The client is 4 yrs away from Medicare and said he was willing to roll the dice just to save money on premiums.

    I advised against that move.

    Should I tell him about the underwriting decision and let him hash this out with his doc or keep silent? How about trying another carrier following the December colonoscopy?
     
    somarco, Nov 17, 2007
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  2. bluemarlin08
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    bluemarlin08 Guru

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    I doubt you are going to get a change in UW even with a clean new colonoscopy. Polyps are often a precurser to developing cancer, although he improved his chances by having them removed, and alerted that he will need continued follow up colonoscopies in the future, don't believe anyone would issue without the rider. I would tell the client and document your conversation, colon surgery is expensive, I had it 2 years ago at 75k for the procedure. I would keep his current coverage but see if he can increase his deductible.
     
  3. salpro22
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    salpro22 Guru

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    Would effect would it have if he talks with his doctor and hashes it out with him or her?

    I'd see what Assurant will do and hope the results came clean from his test in December. I do see a section in their underwriting guidelines pertaining to polyps being ridered, but you well know those guides are not entirely accurate. Perhaps John P. has had some experience with that condition.

    If Assurant cannot do anything and we're talking about an individual that doesn't have much to choose from in the way of a risk pool plan then I'd advise he stay put and suck it up because the potential to develop cancer is not worth the risk to save a few thousand dollars. Then again, if he feels that it is warranted then I wouldn't have an issue signing him up as long as all the cards are out on the table.
     
    salpro22, Nov 17, 2007
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  4. somarco
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    somarco That Medicare Expert Guy

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    I never encourage a client to hide anything from underwriters. He is already a bit touchy over the rider since his doc said there was nothing to worry about.

    Carriers put us in the middle when the doc tells the patient their condition is no big deal then a carrier denies coverage or issues a permanent rider. I've had that happen a few times in the past year or so with PSVT treated with Atenolol and now this. Just last week had an issue where cholesterol readings were high (235) but the doc didn't want to put the pt on cholesterol lowering meds.

    Some docs are quick to script a med while others have to be beat over the head to take action.

    His doc told him there was nothing to worry about and that may be true.

    But the doc isn't paying the claim either.

    Polyps can be a precursor to cancer, depending on the size. These were apparently of sufficient size to create concern for the underwriter.

    Each carrier underwrites differently. I won't offer a plan with a rider in this case. Too much at stake.

    Depending on the outcome of the December test, I may take a run at Aetna or Golden Rule. All other carriers are out of the running.
     
    somarco, Nov 17, 2007
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  5. Mr. Bill
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    Mr. Bill Guru

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    I would leave it be, wouldn't even consider the change. With only 4 years to go the client is best off spending some money at the gambling tables, with better odds than what would happen if he changed carriers, got something, and got dropped.
     
    Mr. Bill, Nov 17, 2007
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  6. James
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    James Guru

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    If his next exam is clean I wouldn't hestitate to make a change. 4 years is very short time span for anything to happen, I would almost say quite impossible. Yet consult a Dr., but I'm confident in my diagnosis!:D
     
    James, Nov 18, 2007
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  7. Bob_The_Insurance_Guy
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    Bob_The_Insurance_Guy Guru

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    It doesn't matter whether the doctor tells the person not to worry about it or not. It is a pre-existing condition.

    You can't unring a bell.

    If I have diabetes, and am on Metformin, then am able to control my blood sugar with diet and exercise, that doesn't mean I no longer have Diabetes. Even if my doctor takes me off the Metformin. I still have diabetes.

    What if Charles Manson said, "I used to kill people, but since I've been in jail, I haven't even shanked someone."

    Just as teenagers with auto insurance, pre-Medicare age with health insurance is a terrible age. It's what I tell my clients is the "black hole" of health coverage. My advice: Get a high deductible - I mean, really high ($25k with World) until they reach Medicare eligibility. DON'T open an HSA, just have the high deductible plan.

    You may still have the rider, but it would cover anything else that arises. Doctors are not underwriters, and will tell the patients what the patient wants to hear, to avoid a law suit. Getting into a he said, I said, you said, underwriting said situation is dangerous.

    DANGER, WILL ROBINSON. WARNING!! WARNING!!

    We, as agents, must tell our prospects and clients what they need to hear, not what they want to hear. As much as it may hurt us financially. I'd rather not be someone's agent, and retain their respect (this way, I can still receive referrals).

    ETHICS: If you lose any sleep over this, then it is not the right thing to do.

    You have to remember, insurance companies don't think logically, they think financially. Your client/prospect is telling you something emotionally. Don't confuse the two. It will get you in trouble.

    Just my two cents.
     
  8. somarco
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    somarco That Medicare Expert Guy

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    Money (my comp) is not the issue. That is why I have told him to refuse the offer from Humana.

    If I can help him find a plan without a rider, then perhaps he will move forward.

    He is in a bit of a mess. His Blue renewal is ridiculous (as it is with all who have been with them any length of time). I don't know if he can afford the renewal or not, but I do know he asked me to help.

    The issue for me is, do I tell him what the underwriters told me or not? I am inclined to keep it to myself rather than upset him over what may be nothing at all.

    My feeling is, he respects my approach even if he is disappointed in the results (higher premium with current carrier). He knows I am not pressing, just to earn a commission. That should be worth something.
     
    somarco, Nov 18, 2007
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  9. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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    stay with blue and help him find a cheaper plan within blue.....and see if you can get an agent of record letter......
     
  10. taterpeeler
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    taterpeeler Guru

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    u can bet your sweet arse humana has documented your phone call and in court they will say they told u the reason, u loose because u did not inform the client of info u had.... if u tell the client get him to sign a letter that u informed the client to cya, then place the policy and move on
     
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