Humana - Contesting My Clients' Claims

[Yagents]

I was wondering if this is also happening to your Humana clients. Over the past few weeks, I've had 3 H clients call me to state that H is asking for additional doctor records, after they've been approved, on this first claim the client sends in.

My client today, owns 10,000 HSA, daughter had pneumonia over 2 years ago, it was disclosed on app. Daughter had ear infection recently, doctor visit was $60 discounted rate, that's the only claim. BUT, H wanted full details and dr records. WTF, the guy has a 10k deductible, and kids get ear infections (so I hear), and all was fully disclosed on the app.

Anyone else have this problem? This is getting rediculous, and makes me hesitant to offer H. No other company I sell does this as often as H.

 

[HealthGuy]

As so it goes through the grapevine I have heard that H1 has recission police who are comped on stinging applicants after the application is submitted. I seriously don't believe Humana wants to stay in individual insurance (under 65) because of different approaches to business they take. Somebody prove me wrong. This post is conjecture anyway I admit.

 

[dgoldenz]

Have had the same thing w/ H1 on several clients. Always resolved, but a big pain for the client. Never once got that from Anthem and I have 5x as many policies with them.

 

[bluemarlin08]

Never have a problem with BC, all problems with other carriers.

 

[ABC]

I would stop selling them. Legit claims need to be processed with out all the BS.

 

[somarco]

I have had a few, all resolved. H1 has paid some very big claims for me including 2 that were investigated. Both of those xs of $150k.

 

[pahealthquotes]

I have had a few, all resolved. H1 has paid some very big claims for me including 2 that were investigated. Both of those xs of $150k.

isint that the job of the carrier? to pay claims? Whats up with Humana?

 

[somarco]

All carriers have a list of ICD-9 codes that can trigger further investigation. With the new anti-rescission laws that basically encourage applicants to lie on the application, I expect post issue underwriting to become more prevalent.

Or they could just do like Medicare and Medicaid and deny more claims than any commercial carrier.

 

[Crabcake Johnny]

A few agents have emailed me stating that post 9/23 carrier cannot rescind.

This is not correct. Carriers can rescind but they have to prove intent to commit fraud.

That's rather easy when a client omits something like a current medication or health condition.

You "forgot" you're diabetic? Unlikely.

 

[somarco]

Carriers could always rescind for fraud or misrepresentation. Difference now is they can only rescind going forward, not retroactively.

So if you have a condition you believe you can slip by the underwriter, go for it. Get as much of your treatment paid for before they cancel your policy.