Loss Runs on Individual health

May 8, 2008

  1. Chkndinner14
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    Chkndinner14 Super Genius

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    There is CLUE and ADD reports for home and auto insurance, which provides claims history.

    There is Loss Runs for Commercial P & C.

    Why not loss runs on Individual health? It would lower recisions and let a carrier know what they are dealing with. All the information is tracked on EOB forms, what is the problem of consolidating it on one sheet, or several, sheets of paper?

    The P & C business got over the privacy hurdle, what is stopping the health industry?
     
  2. insuremojo
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    insuremojo Super Genius

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    It's not called loss runs with health insurance.

    3 letters for you...M..I..B..

    Trouble is it's not always checked until there's a claim.
     
  3. somarco
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    somarco That Medicare Expert Guy

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    So there is a HIPAA law for P&C?

    As I understand it, CLUE is on the home, not the homeowner. Can't say about ADD.

    Individual health runs on consumers (I suspect) follow an entirely different set of rules. I don't recall ever walking into a SF office and being told I had to remain in a designated area if another customer was being served.

    But go to pick up your Rx and you must wait behind the yellow line.

    Health (and life) carriers have access to MIB and Milliman Intelliscript. Seems to me that is just as helpful, if not more so, than a simple loss run.

    Even if loss runs were avaialble, I see no benefit.

    So Mrs. Jones, I see you paid your carrier $6000 last year and ran up $12,000 in claims. What caused this?

    I delivered twins . . . and my husband was the cause.
     
    somarco, May 8, 2008
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  4. djs
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    djs Super Moderator Moderator

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    CLUE is on both the homeowner and the home (or the driver and the auto). I've had to explain lots of claims from previous homeowners, or rental claims unrelated to the current house.

    I don't think HIPAA actually prevents someone from authorizing you pulling a medical history for insurance determination. It does prevent someone from pulling it without authorization, and to use reasonable care from others accidently gaining access (hence the yellow line).

    HIPAA does get used as a convenient excuse.

    Unfortunately, MIB is not comprehensive, from what I understand. But then again, neither is the CLUE report.

    Dan
     
    djs, May 8, 2008
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  5. Chkndinner14
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    Chkndinner14 Super Genius

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    MIB is not even close to a loss run.

    MIB = When an application is made to an MIB Member company, any information that is of significance to health or longevity (whether admitted on the application or discovered during the underwriting process) is sent to MIB by the Member company in a coded, encrypted format.


    Loss runs = Detailed or simplified claims history.
     
  6. Chkndinner14
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    Chkndinner14 Super Genius

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    That is exactly the point, some losses are easily explained and some are not. I would assume that Health Underwriters are concerned with two things, frequency and severity.

    Severity- Heart problems, cancer, aids,

    Frequency- Goes to the doctor when they stub their toe, or sneeze.

    Both would be unprofitable for the company. Loss runs would tell the picture. I am sure any underwriter would love to have this information.
     
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