NEED HELP WITH SPECIAL CASE

Discussion in 'Health Insurance and Ancillary Benefits' started by aufan, Nov 6, 2006.

  1. aufan
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    aufan Super Genius

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    Ok guys. Have a potential female client 5'7" 230 lbs. She is needing life, health and disability. I write health through Assurant and USHealth, disability through Assurity and life through multiple carriers.

    I believe I can get her written for most all of her needs, but she says she is planning on having gastric bypass surgery. I was told by a coleague to get her written on an individual plan before her surgery and she will need to make sure she does not file a claim for her surgery. He says she would be uninsurable after she has the surgery.

    What sorts of dilemnas do you see this case presenting?
     
  2. Crabcake Johnny
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    Crabcake Johnny Guru

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    Tell your colleague to go and turn in his insurance license before he really harms someone. She cannot be written though any individual carrier until after the surgery.
     
  3. aufan
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    aufan Super Genius

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    Thanks John....My gut had already told me that was not the right thing to do, but I wanted some opinions on it before I progress any further.

    Should I let my client know that she will be affecting her insurability if she chooses to have the surgery?
     
  4. Crabcake Johnny
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    Crabcake Johnny Guru

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    If she has current coverage she needs to stay put. If she decides to have the surgery on her current plan she won't be able to obtain insurance through most carriers even after the surgery.

    If she doesn't have any coverage then she can't make it known to an agent that she's planning on having any type of future surgery. She can indeed get a plan, but she can never use it for gastric bypass.

    First of all, highly doubtful that she'd get pre-authorization for a gastric bypass procedure in the first place. It's normally only authorized in very extreme cases where the client is so obese that their life is in danger.
     
  5. aufan
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    aufan Super Genius

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    From the initial phone interview, client is currently on Cobra from ex-husband's group plan through Unicare.

    So basically I should just educate her on the ramifications of having or not having the surgery and future insurability?
     
  6. James
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    James Guru

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    I don't know, 5'7" and 230 lbs and Gastric Bypass seems a little like overkill! What does she do for a living, DI can be real funny with Occupation.
     
  7. Crabcake Johnny
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    Crabcake Johnny Guru

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    Stay away from giving her medical advice like "you shouldn't get the surgery because it'll make you uninsurable." That's a lawsuit waiting to happen.

    All you need to tell her is that if she plans on having any type of surgery she's ineligible for an individual plan. Past that she needs to take her doctor's advice for her couse of action.
     
  8. James
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    James Guru

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    I agree with John, don't give medical advise even referring to health insurance in the future. Yet if you walk away, which is what I basically would do if she is serious about this procedure give her some literture from the AMA and this procedure. God, it reaks havoc with so many and it should be outlawed unless mortality is involved with seriously overwieght people and 5'7" and 230lbs isn't that seriously overwieght to suggest mortality is involved. Yet though there is now new procedures better then they did just a year ago, hell they even have a rubber band basically that is adjustable or removeable which seems promising for many, as a failure in life style doesn't have to be life threatening or living the rest of ones life with basically no stomach which isn't pretty!
     
  9. aufan
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    aufan Super Genius

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    Thanks to both James and John for input. However, I do see particular problems that can arise no matter what MY decision is.

    My instincts are right now to respectfully decline her requests due to her disclosure about potential surgery. My fear however is that if she were to not secure individual coverage and she became sick that I would somehow be partially liable. Am I overreacting to this particular case?
     
  10. STIBROKER
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    STIBROKER The Guy that GREENSKY can't not put on ignore. Moderator

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    has she asked Unicare if they would convert her current cobra plan to able to keep it past the 18 mo's.....
     
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