Medicare Supplement Underwriting ?

[sman]

The only time they typically won't tell you is if it's something not disclosed on the application. I've had them tell me the following reasons without giving specifics:

Something disclosed in telephone interview
Claims history
Rx history (again, not disclosed on the app)

When it's one of the above reasons, some carriers won't disclose the specifics to the agent.

 

[vic120]

There is a HIPAA disclosure baked into the app that includes sharing info with the agent. Don't know I have ever been denied underwriting info on a Medigap app.

I have had a problem getting that info from mutual and AARP. I have not had this issue with any of the others

 

[beachbum2012]

The only time they typically won't tell you is if it's something not disclosed on the application. I've had them tell me the following reasons without giving specifics:

Something disclosed in telephone interview
Claims history
Rx history (again, not disclosed on the app)

When it's one of the above reasons, some carriers won't disclose the specifics to the agent.

Ok, so I had a client recently declined and the carrier said it was for "information received in the phone interview". Maybe it's carrier-specific, but will they automatically send something to the applicant letting them know why they were turned down? Do they have to request it in writing first? At this point I can only guess what the issue was and really don't know which carrier to try next. How do you guys usually proceed?

In general, do you guys always discuss the case with an underwriter of the carrier you're using before submitting the app, or just do it and hope for the best and then just use the next company if they're declined? 90%+ of my business so far has been T65, but obviously more and more will be underwritten as time goes on and my book needs to be flipped. Most of the time when a client is declined with one carrier another will take them, but even when this happens it creates more headaches and wasted time than seems necessary.

 

[hunterhb]

Sorry to bump an old thread, but I thought they couldn't tell you the reason for decline because of HIPAA?

If the application has a health questionnaire, which every MediGap app I ever saw does, then they are offering up health information willingly for insurance enrollment purposes. Out here in CA, they are required to fill out that part of the application - If no GI is available. Also, MediGap applications have a "consent to release medical record information" page, for purpose of health history screening, if applicable. After they sign consent, it of course cannot be a HIPAA violation.


Disclosure - I am not a representative of HIPAA or the California Dept of Insurance. All posts are thoughts and opinions unto myself, not on behalf of any company or entity.

 

[sman]

Ok, so I had a client recently declined and the carrier said it was for "information received in the phone interview". Maybe it's carrier-specific, but will they automatically send something to the applicant letting them know why they were turned down? Do they have to request it in writing first? At this point I can only guess what the issue was and really don't know which carrier to try next. How do you guys usually proceed?

Just like everything else, it's carrier specific. Some will give specifics in the letter they mail to the client. Those that don't will require a request in writing from the applicant. As for how to proceed, that depends on the reason they were declined. If it's for something another carrier will accept, then you move forward with an application for the next carrier. This assumes of course you find out the specific reason.

In general, do you guys always discuss the case with an underwriter of the carrier you're using before submitting the app, or just do it and hope for the best and then just use the next company if they're declined? 90%+ of my business so far has been T65, but obviously more and more will be underwritten as time goes on and my book needs to be flipped. Most of the time when a client is declined with one carrier another will take them, but even when this happens it creates more headaches and wasted time than seems necessary.

I don't discuss a case with an underwriter unless it's a questionable case. If it is I will call and get a feel for whether or not to even submit the app. Many times they will just say, "you can submit and we'll review". Other times they will say, "we wouldn't offer coverage". In that scenario you know not to waste yours or the clients time.

With the majority of carriers offering e-apps, it really isn't a ton of wasted time. It really doesn't get much easier from a service stand point than Med Supps.

 

[somarco]

I call on every decline. I also pre-screen underwritten apps before submitting so I have an idea if they will pass or not.

Most of the time the underwriter will tell me they are taking medication X and it is used for Ebola.

Did you ask if they have Ebola? The drug is also used for PMS.

No, we just assume they have Ebola.

Those types of conversations send me through the roof.

I had one application rejected a few years ago because the lady was underweight. I should have noticed, but didn't. I usually check the heavy ones to see if they are under the catch and release program. Never occurs to me someone will be too thin.

In this case the lady was 2 pounds too light. They refused to approve her.

 

[Todd King]

If the application has a health questionnaire, which every MediGap app I ever saw does, then they are offering up health information willingly for insurance enrollment purposes. Out here in CA, they are required to fill out that part of the application - If no GI is available. Also, MediGap applications have a "consent to release medical record information" page, for purpose of health history screening, if applicable. After they sign consent, it of course cannot be a HIPAA violation.


Disclosure - I am not a representative of HIPAA or the California Dept of Insurance. All posts are thoughts and opinions unto myself, not on behalf of any company or entity.

That consent is only for the company to obtain UW info. It's not used so that they can give the agent medical info on the client. Giving medical info to the agent about the client is still a HIPPA violation.

Many times you can call a company and narrow down the reasons for the decline simply by having the UW tell you what it's not. For example, if you can get the UW to narrow it down to which question it pertains to and let's say that particular question has 3 conditions in there, you might get the UW to tell you what 2 conditions it's not. This works for me a great deal of the time.

 

[somarco]

Beg to differ Tom, but ...........


I authorize any health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy, pharmacy benefit

manager, medical facility, or other health care provider that has provided services, treatment or payment to me, or on my

behalf, within the past 10 years ("My Providers"), or consumer reporting agency, or the Medical Information Bureau, to dis-
close my entire medical record and any other protected health information concerning me to xxxx insurance company

Insurance Company ("xxxxx") and its agents, employees and representatives.


I don't specifically recall a Medigap or major medical carrier refusing to provide me with information when I asked.

Before Obamacare when the agent took the application, including medical history, doc names, address & Rx history we already had that information (assuming the applicant told us the truth). If a carrier discovered something via MIB or Milliman Telescript that was different.

 

[senior-advisor-indiana]

In my experience it is very rare when the company will tell the agent why it is a decline. Speaking only of med supps if course. Are you guys putting your name down on the hippa form or something?

 

[somarco]

No, I sign as agent.

Maybe you don't know how to ask?

I have very few declines, except where the applicant lied. With a dozen years in IFP I might have had half a dozen declines. Probably about that many Medigap apps but over a shorter time frame. A couple of those because the applicant lied about medications that showed up in the Rx report.

That being said the worst carrier to get anything out of, including when the app is pended for information, is Aetna.