Health Insurance Carriers Declining People and Not Saying Why?

[riskybiz]

Not trying to be argumentative, trying to understand the situation, but here's my question:

Why would she need a "more inclusive pap smear-type test" if her original was "normal" and unremarkable?

She was asked to participate in a clinical research study for a more inclusive test. The test was not due to any medical problems and she was compensated for her time. This could be the reason for the decline, I don't know, just tell her why.

They sent the exact same letter for the declination after the appeal and submission od additonal information. If anything go into more detail and give us a clue.

 

[agent4sail]

Errors frequently occur do to erroneous information contained in MIB records. Your client may need to order her MIB and see what information is being reported to the carrier. I was declined for a health insurance policy because of my MIB. When I checked the records I found that I had many, many issues I did not know I had. The report listed 3 surgeries I wasn't aware of. After carefully checking where this info originated, I found another lady with my name, same city, same age, same physician, her records had been combined with mine. It was being furnished by MIB as my medical records. It took many letters and the threat of legal action before it was corrected. If I had not been aware of the MIB reporting, I may never have known how to get my medical records corrected.

 

[somarco]

She was asked to participate in a clinical research study for a more inclusive test. The test was not due to any medical problems and she was compensated for her time. This could be the reason for the decline

Aha!

Good chance that trial, or some information from it, showed up at MIB.

If so, the carrier picked that up and declined. It can happen with other carriers as well.

If she took meds as part of the trial, that will almost certainly be reported to Intelliscripts (or some similar organization).

Coventry is about as squirrelly as any carrier when it comes to underwriting. I refer to them and Jekyll & Hyde because you never know what you will get.

You need to make a case to the underwriter, either Coventry or the next carrier.

Make your case in a logical fashion.

She did not have an abnormal pap.

She opted to participate in a clinical study because . . .(insert explanation here).

The study results showed . . . (insert outcome here).

Not saying it will work but you have to at least try and be proactive, not reactive.

 

[Crabcake Johnny]

If indeed she is healthy you have a good chance by submitting it for review with ALL of the information. I don't see where participating in a clinical study is a reason for decline.

That said, I'm gonna dial up my underwriter today. I have a bad feeling if she took any experimental drugs that could be game, set and match.

 

[CPACINS]

She was asked to participate in a clinical research study for a more inclusive test. The test was not due to any medical problems and she was compensated for her time. This could be the reason for the decline, I don't know, just tell her why.

They sent the exact same letter for the declination after the appeal and submission od additonal information. If anything go into more detail and give us a clue.

She is being declined because of the colposcope. Usually the only reason for a colposcope is irregular pap. Coventry is seing that on her record and it's an auto-decline. You will need to get something stating from the Dr that she did this for a research trial and that nothing was wrong. It will need to be something different than just her records. Like a letter from where the trial took place and why and then file the appeal.

 

[Crabcake Johnny]

Just off the phone with an underwriter; taking part in a study does not trigger a decline. However, I was correct about any meds. You did not state whether or not she took any experimental medication but if she did that could be a reason for the decline - subject to UW review of course.

 

[riskybiz]

Thank you very much for all of your input, it has been extremely helpful!

I should not have to go out and seek out all of this information for something like this, the carrier could and should be a little more helpful in ascertaining the reason why someone is declined. I have requested more specific info from the underwriter and hopefully will hear something in the" next couple of weeks!" talk about customer service.

We are going to try another carrier.

 

[Crabcake Johnny]

Personally, going to another carrier without knowing the specific reason for the decline is like shooting in the dark. You need to know the reason before you go off to carrier B.

 

[somarco]

I should not have to go out and seek out all of this information for something like this,

Nope, that's what you get paid for . . .

 

[riskybiz]

Nope, that's what you get paid for . . .

I should not have to go on a message board to try to find out why my client was declined. The insurance company should be able to tell my client specificlly why they are being declined.
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Personally, going to another carrier without knowing the specific reason for the decline is like shooting in the dark. You need to know the reason before you go off to carrier B.

This has been going on for 2 months. Her Cobra coverage is about to expire. What else can I do, keep appealing? Short term could be tricky, because technically she has been declined.