Med Supp (Lumico) question

Aug 9, 2019

  1. somarco
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    somarco GA Medicare Expert

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    Any reason why that (Lymphedema) was not discovered in your pre-screen when you found out about the hernia that did not need surgery?
     
    somarco, Aug 13, 2019
    #11
  2. Limozine
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    Limozine Expert

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    I honestly don't have a good answer. I could have sworn I asked all of the questions and she answered "no" during the pre-screen. But when I asked again, as I was completing the app, she revealed the lymphedema so I stopped right there.
     
  3. somarco
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    somarco GA Medicare Expert

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    Not brow-beating. Just curious why it came up now. Did she have a hearing/reading problem or a memory problem?

    All my sales are over the phone. Before pre-screening I email them a copy of the health questions only (not the full app). I tell them to review, get a full list of their med's, doc names and addresses BEFORE we start the app.

    I want to make sure there are no surprises.

    I still get a few that go off the rails in underwriting. Not many. Maybe a couple per year.

    Also get some sidetracked during pre-screen. Had that happen last year.

    Client called to let me know he was changing his Medigap plan to another carrier unless I could offer the same plan at around the same price. This guy has been a client for 6 or 7 years.

    We talked for a few minutes. I actually READ the questions to him but alsor told him I would email the questions.

    When I got to the one about "advised to have . . . but not yet completed" he stopped me right there.

    His doc has told him on several occasions he needs rotator cuff surgery. Keeps putting it off. In his mind he doesn't (yet) need it.

    I said you can keep your current plan, have the surgery, then we look at changing after it is done.

    Or you can take that other plan, and HOPE they pay your claim.

    Which option sounds better to you?
     
    somarco, Aug 13, 2019
    #13
  4. Limozine
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    Limozine Expert

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    I fairly new at this, but I usually do the same (send just the health questions). In this case I didn't - I just read them over the phone. She kept interrupting me to volunteer information, opinions, etc. and I MAY have skipped that last question by mistake, so I can't lay all of the blame on her.

    Thanks for the good information though.
     
  5. somarco
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    somarco GA Medicare Expert

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    I hate when I have folks like that.

    I give them plenty of time to talk about . . . whatever they want . . . as long as we keep on topic. But I make a note of their chattiness when doing an underwritten app.

    We go over the questions and I explain the process.



    An underwriter will call to review your application. They will take each question and drill down to make sure you read and understood the question. Same thing for your medications.

    Pretend you are on the witness stand and Perry Mason is grilling you. (If you don't know who Perry Mason is you missed a classic). Just answer the questions AS ASKED. Don't volunteer anything that is not specifically asked. DON'T EMBELLISH. Keep your answer short and to the point. Yes or no if possible.

    Oh, and keep in mind, this call is recorded and will be part of your underwriting file.

    Be honest above all else. Just the facts (Sgt Friday).
     
    somarco, Aug 13, 2019
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  6. Limozine
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    Limozine Expert

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    But doesn't that circle us back around to the original question? Let's assume for a minute that the Lymphedema didn't exist, and the only problem is the hernia. The health questions didn't ask if she had a hernia, and her doctor had advised her NOT to have the surgery, so why would she need to volunteer that information?

    Again, I'm not trying to be difficult...it's just that I'm new to this and want to understand when and when not to volunteer information that isn't in the health questions.
     
  7. somarco
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    somarco GA Medicare Expert

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    You said she was a talker. Good chance she would have gotten off track at some point.

    Many apps have a catch-all question. Something to the effect of "is there any other condition diagnosed or treated that has not been asked".

    If the app doesn't specifically ask that good chance the underwriter will if they are doing their job. The carrier is not SUPPOSED to ask anything that is not specifically on the app . . . but that doesn't stop them from trying.

    Beyond that, more carriers are looking at Rx history. They discovered your med's tell a lot more about your health than any questions.

    A combination of ACE inhibitor or Beta blocker plus a diuretic often indicates underlying serious heart conditions. History of heart attack, CHF or cardiomyopathy is often treated with those common BP med's.

    When I see those combinations I has if they have any history of heart trouble.

    Some docs don't tell their patient how serious their health is . . . others may mention it but the patient isn't listening or paying attention.

    Regardless of the reason you can get a decline or claim denial that will create problems for you and your client.

    I am perhaps overly cautious. Have had a few situations come back and bite me. Includes a couple of policy rescissions. Those are not fun.

    Out of the literally thousands of apps I have written over the years I might have 10 apps/policies where the claim was denied and/or the policy rescinded.

    If an application is investigated after the policy is issued the carrier will come back and ask if you were aware of condition X.

    You don't ever want to be in a situation where you have to say you were but didn't think it was important.
     
    somarco, Aug 13, 2019
    #17
  8. Bob L
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    Bob L Super Genius

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    This stuff is precisely why I have begun to record all my appointments with my laptop, starting a few months ago when a client falsely told Aetna I did not tell her about the deductible on T3 + drugs during my PDP presentation, and halfway through the year started taking a brand name drug. (The complaint ended up adjudicated as "inconclusive." That resulted in no action against me, but still got under my craw.)

    When you have a complete voice recording of everything the client has (or hasn't) told you, it'll go a long way to exonerating you if there is a brouhaha later. And BTW, I do not tell the client they're being recorded. That may be illegal in some states but not here.

    All that being said, I've never had a claim refused or policy rescinded, with many hundreds of Medicare clients. As someone else already posted, the script check reveals more than almost anything else the client is hiding, or forgot about.
     
    Bob L, Aug 13, 2019
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  9. goillini52
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    goillini52 KeepAmericaGreat...Eat Bacon & BUILD THAT WALL!!!

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    You need to be sure to check the Underwriting Guides too for each company. Besides the Height/Weight chart and RX KO list, you'll also find health conditions/situations that will cause a decline that aren't on the app. :yes:
     
  10. somarco
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    somarco GA Medicare Expert

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    This (below) came from Bankers Fidelity UG. At least one other carrier (can't recall which) will also decline if you are taking 3 or more BP meds including the following. You won't find it in THEIR underwriting guide. I found out because of an app that was declined

    A combination of ACE inhibitor or Beta blocker plus a diuretic often indicates underlying serious heart conditions. History of heart attack, CHF or cardiomyopathy is often treated with those common BP med's.
     
    somarco, Aug 13, 2019
    #20
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