Oxford Life - Why or Why Not?

[Todd King]

I guess it's a damned if you do and damned if you don't deal, but I have to admit that I'm not a huge fan of this new process where you just get a flat approve or decline with no more information. The old interview was a pain, but at least the meds that showed up were brought out into the open so I could hear what we were dealing with in case of a decline.

Okay, I'll try to address this and see what they say.

 

[JoshC]

Okay, I'll try to address this and see what they say.

And I guess more importantly, how are dual purpose meds handled since there is no interview to allow the PI to clarify?

 

[Todd King]

Josh,
Here is the answer I got back. Feel free to pick it apart. I already have.

The new process does not have the ability for an appeal if declined. That is a difference we are hearing about but the underwriting criteria and outcome of the decision should remain the same. In a case like this our previous process would not have given the agent or client detail on the reason for the decline. The agent might make assumptions based on the medications we asked but again the result and information given to the agent and client should be the same.

The second part of your question on dual purpose medications, the new process is able to make assessment of these medications based on the history, dates of prescriptions, who prescribed it, etc to make determination of dual purpose indications. We are a couple of months in to the process and we see consistent results in approval percentages to our previous process. It appears to be working very well and hearing really good feedback from most agents.

 

[JoshC]

Josh,
Here is the answer I got back. Feel free to pick it apart. I already have.

The new process does not have the ability for an appeal if declined. That is a difference we are hearing about but the underwriting criteria and outcome of the decision should remain the same. In a case like this our previous process would not have given the agent or client detail on the reason for the decline. The agent might make assumptions based on the medications we asked but again the result and information given to the agent and client should be the same.

The second part of your question on dual purpose medications, the new process is able to make assessment of these medications based on the history, dates of prescriptions, who prescribed it, etc to make determination of dual purpose indications. We are a couple of months in to the process and we see consistent results in approval percentages to our previous process. It appears to be working very well and hearing really good feedback from most agents.

Thanks Todd. I have had a few with them get approved after an initial decline because the meds were last filled more than two years prior. I can think of two off the top of my head that were kicked for nitro but approved in the end because of the time window. Hopefully the new system sticks to the lookback period on the app.

 

[Todd King]

Thanks Todd. I have had a few with them get approved after an initial decline because the meds were last filled more than two years prior. I can think of two off the top of my head that were kicked for nitro but approved in the end because of the time window. Hopefully the new system sticks to the lookback period on the app.

The new system will stick to the lookback periods, but the problem I see is that you won't have a chance to talk with the UW about it before it is declined, even if you know going in that a particular medication has multiple uses and your client is not using it for a declinable condition. The algorithm will kick it out.

So, I'm just saying all of this to show that, even though the new system is quicker, it is going to have it's flaws. There is a point when automation can become unhumanly bad.

I just went over some of this stuff with my guy at Oxford. We'll see.

 

[Biggin]

The person I talked to was giving me a lot of "possiblys" and "maybes" and "more than likelys" So I asked her to ask someone that can tell me "will" or "won't". She went to speak to someone else and gave me the "won't". So ya, who knows. How about I submit the app and see what happens. I'll withdraw if they don't pay.

So I thought I'd report back. My client takes a Bayer low dose aspirin and no other RX. Bout 5 years ago she took a cholesterol med but the Dr. took her off it. Cholesterol is fine without it..... Oxford declined due to RX history. She's been a medicare client of mine for the last 8 years so I know what meds she takes. Also had another easy case declined with them last month, a Biggn. So Transamerica is collecting his money instead. Something fishy going on at Oxford.

 

[Todd King]

Thank you, I'll report back. Did you try to appeal this? You probably should have.

 

[Biggin]

Thank you, I'll report back. Did you try to appeal this? You probably should have.

they said the only appeal was for the client to appeal to malanin lol whatever that place is called