I Don't Know Why Blue Cross Rejected Me

[somarco]

Got a call earlier this week from a guy whose COBRA was expiring. Said he was rejected by Blue and having trouble finding coverage.

Could I help?

Possibly.

According to him his only issue is he smoke an occasional cigarette, might go through a pack a month, and takes cholesterol meds.

Somehow I have a feeling there is more to the story.

Just the usual aches and pains for a 55 year old guy. Nothing major. Oh, and I also applied with Humana.

What did they say?

Nothing yet, still in underwriting.

OK . . . here is an app for Aetna. Fill it out & fax it back, I will look it over and let you know.

Next day based on what I saw, it was going to be a bit of a challenge, but no big deal. Even pre-screened him with Aetna, Cigna and a few others. Aetna at +30% seemed like the best shot.

We submitted an app to Aetna yesterday.

This AM he emails me the rejection letter from Humana.

Seems in addition to the cholesterol and tobacco, he also has COPD, elevated PSA and an enlarged prostate plus a couple of minor issues.

Somehow the COPD and elevated PSA never came up in earlier conversation.

 

[dgoldenz]

Why would COPD and PSA's come up? He's a perfectly healthy individual. Nothing to see here, just rubber-stamp the approval.

 

[TXINSURANCE]

So how is your client not lying to you? Or am I reading this wrong? Next!

 

[DS4]

I'm glad it's not only me that gets these types of applicants.

 

[somarco]

Why would COPD and PSA's come up?

Humana got it via APS.

Sneaky carriers are unwilling to accept things at face value.

 

[HealthGuy]

And people wonder why I am reluctant to usually take the time to drive and see them face to face. They just don't get it that in our business about 50% of the time deals go south because EVERYBODY is so so healthy.

 

[somarco]

My rejection rate on apps is less than 5%, but I do pass over a lot of prospects before ever getting to the app submission stage. This one slipped up on me as I was pushing to meet a time crunch before his COBRA ran out.

This is the first time in quite a while I have had to tell someone to cancel the app while it is in underwriting.

 

[bill3173]

My rejection rate on apps is less than 5%, but I do pass over a lot of prospects before ever getting to the app submission stage. This one slipped up on me as I was pushing to meet a time crunch before his COBRA ran out.

This is the first time in quite a while I have had to tell someone to cancel the app while it is in underwriting.

It's really sad and funny at the same time, when I get these peeps that the Cobra is running out, and they have no health problems, they just forgot that they were paying $650/month.

I give them the benefit of the doubt in most cases, if they absolutely refuse to come clean and sometimes place them in the State plan, after the uw finds out about the heart stents, multiple personality disorder, kidney removal, etc.

 

[somarco]

Most of my rejected apps were borderline going in and I informed my client of that. Still, I have good overall success even with marginal risks.

It is very rare that someone doesn't come clean with me. I don't know if they are in denial about their health, or their doc hasn't leveled with them, or what.

I have had 4 cases this year rejected in underwriting that were a total surprise. In 2 of the cases the prospect would not call me back and of course I could get almost nothing from the carrier due to PHI.

In the other two cases, there were underlying cardiac conditions that the client either insisted they did not know about or never considered them serious. On one of those cases I was able to pick up an AOR so I am getting paid something for my time.

 

[TonyC]

Yep...gotta do a good pre-qual before taking a full apl.

Good Work Bob...you're the Best!