HealthNet

[TXINSURANCE]

I have had policies rescinded for complete BS reasons. It depends a lot on the carrier. For example one rescind the guy goes to get Blood Pressure RX 1.5 years into the policy. Carrier pulls records and finds 5 or 6 years ago a doctors note for slightly elevated reading. The guy claims he was stuck in traffic and running late for his docs appointment. One reading was slightly elevated, then the next were fine - all other readings were fine since then as well. He never had any blood pressure RX or other history.

The question on the application read ... "ever" had high blood pressure, and he answered no.

My point here is usually the client is full of BS - I happened to know this guy personally so it holds more weight. They refunded 1.5 years of premium which was enough to cover his RX for a year (and then some) and I put him on a another carrier and enjoyed a $800+ charge back - that was great.

A lot of companies have installed new computer programs to catch and track common first year claims. Carriers will jump through hoops to prove pre ex on claims over an undisclosed dollar amount. This is all tracked back to the original underwriter, who is scored on usage of approved applications as well.

There is a lot going on most people are unaware - it is called underwriting, and that is the game at the moment.

 

[Soaringagent]

Who is the agent for this HealthNet account?

 

[TXINSURANCE]

Hopefully Ehealth... lol

 

[Dave020]

Assuming it's the case that was in the newspaper (LA Times?), then it was not Ehealth, it was a private agent. A private agent who apparently took it upon himself to fill out the application for this client (supposedly).

I wonder what percentage of recissions are on applications filled out by the agent vs those filled out by the subscriber?

That could be a telling stat. In this case she claims she was busy doing hair while he took the application and was not focused on the questions he was asking.

I suspect soon the carriers will add a section onto the application that specifically requires both signatures as to who filled it out.

In this case it is really sad because the subscriber already had a health insurance policy with another carrier. So it looks like the agent did a policy switch and left off a few things (like she has cancer) from the application.

Kind of hard to hammer the carrier on this one.

 

[GreenSky]

In this case it is really sad because the subscriber already had a health insurance policy with another carrier. So it looks like the agent did a policy switch and left off a few things (like she has cancer) from the application.

So the fallout from this....
...get rid of the damn agents!

I just wonder if this was a new agent who was too inexperienced to know better, or just a thief.

After seeing the stupid questions in meetings and elsewhere from agents who have been licensed for many years, I am not surprised at this type of thing. While this probably was an intentional act, how about all the errors because of "non-professional" licensed agents?

Rick

 

[TXINSURANCE]

Ultimately it comes down to the agents fault , of course.

Carriers want UNIVERSAL MANDATED HEALTH CARE, not a government plan - but a mandated plan. When something is mandated you don't need brokers.

Look at GI states and MA if you need some examples.

The carriers will win big time if we get some form of Universal Coverage, and the individual market will thrive - just not with your hands in the cookie jar.

 

[Dave020]

So the fallout from this....
...get rid of the damn agents!

I just wonder if this was a new agent who was too inexperienced to know better, or just a thief.

After seeing the stupid questions in meetings and elsewhere from agents who have been licensed for many years, I am not surprised at this type of thing. While this probably was an intentional act, how about all the errors because of "non-professional" licensed agents?

Rick

Better and worse I think. Better as carriers know that agents are a very inexpensive distribution channel for their products. Worse because most likely the fallout from this kind of thing is going to be mandatory in class or online training classes (with of course no CE) on how to sell their products...ugh!

I have not gone to one of those stupid meetings you refer to in several years for exactly that reason. I believe that unless you do health insurance full time, don't do it at all.

So looking forward to those two hour training classes...NOT!

 

[Crabcake Johnny]

I agree with TX on this one - once we get mandated coverage we're out of a job - plain and simple. If any carrier threw out 5% commish consider it a gift.

It's not "if" but "when" we'll get mandated coverage. We'll never have gov't run universal health care - never. But an expanded version of what Mass. is doing is coming.

 

[J.R.]

Some of that info is available to participating carrierss from MIB. There is at least one company (can't recall the name) who tracks prescribed meds for the last 5 years. Carriers like Humana & Aetna check MIB and (the Rx source) and compare results against your app to see if you lied or not.

Quite true, but it's not universal.

 

[J.R.]

Some of that info is available to participating carrierss from MIB. There is at least one company (can't recall the name) who tracks prescribed meds for the last 5 years. Carriers like Humana & Aetna check MIB and (the Rx source) and compare results against your app to see if you lied or not.

Key word being participating.