Question on MIB/Pharmacy Benefit Managers

[SammyJ]

Based on what? Outside proving the insured didn't sign the app they can't win. I actually had a $25k 5 star graded pay in the 16th month. It only took 6 weeks to pay. I was shocked

 

[goillini52]

It's not a matter of how many will want to pay (try zero), but a matter of whats legal and permissable.

Of course no company ever wants to pay a claim.

Why wouldn't it be legal and permissible to not pay a claim that's in the contestable period if they can't check the insured's medical records, especially if that's covered on the app? That's what the contestable period's for.

 

[Klutch]

Of course no company ever wants to pay a claim.

Why wouldn't it be legal and permissible to not pay a claim that's in the contestable period if they can't check the insured's medical records, especially if that's covered on the app? That's what the contestable period's for.

Where does it say in writing that they legally can deny claims in the contestable period if they can't check medical records? That's my question.

 

[goillini52]

Where does it say in writing that they legally can deny claims in the contestable period if they can't check medical records? That's my question.

For KSKJ it's on page 6 of their app.

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I called ACI and asked them this question. Their medical review board said that if they can't review the insured's medical records during the 2 year contestability period.....the claim won't be paid.

 

[bboman23]

For KSKJ it's on page 6 of their app.

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I called ACI and asked them this question. Their medical review board said that if they can't review the insured's medical records during the 2 year contestability period.....the claim won't be paid.

You call more companies in a week than I do in a year!

 

[PA Bill]

You call more companies in a week than I do in a year!

About as much fun as calling the dentist.

 

[goillini52]

You call more companies in a week than I do in a year!

I'm a curious guy. When I want to know or verify something, instead of going back and forth...I go to the source.

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About as much fun as calling the dentist.

I wish these companies would get some decent "hold music".

The 1st guy I talked to didn't know what MIB was. I told him he'd better connect me to someone that did.

 

[Ksutton]

I have been calling the companies in the house if I need any verification. I think it also helps with credibility For the client ... I'll put it on speaker and build a little rapport if we have to hold or continue on with my presentation until someone picks up ....... Or play with their dog



Too fast to catch - but you get it

 

[goillini52]

I have been calling the companies in the house if I need any verification. I think it also helps with credibility For the client ... I'll put it on speaker and build a little rapport if we have to hold or continue on with my presentation until someone picks up ....... Or play with their dog

View attachment 3659

Too fast to catch - but you get it

That doesn't look like a FE house...no crap on the floor.