Some Agents Need to Do Their Homework

A recent referral was switched from one health plan to another for no other reason than a new first year commission. The lady's son had tonsillitis and within 6 weeks of the switch, the tonsils had to come out.

Seasoned agents know what happened next - claim denied. There is a six month wait on tonsillectomy in NC with most plans, regardless of prior coverage.

When I hear agent talking about rolling business every year, all I can think of is not repeatable.

Rolling people over 60, 2 year wait for varicose vein surgery. There are time bombs in health plans in many States.

Unfortunately, it's not all the agent's fault. The carriers, for the most part, don't advertise these restrictions.
 
What gets me is kids are GI and pre-ex are covered due to PPACA, but the policy exclusions still stand. Can someone splain this?

Goldenrule's 6 mo waiting period on reproductive organs is a non starter for me. Women have lots of organs that fall under that definition, it's like 1/3 of their body.
 
What gets me is kids are GI and pre-ex are covered due to PPACA, but the policy exclusions still stand. Can someone splain this?

Goldenrule's 6 mo waiting period on reproductive organs is a non starter for me. Women have lots of organs that fall under that definition, it's like 1/3 of their body.

So basically limited coverage for six months. Would a bladder infection get paid?
 
So basically limited coverage for six months. Would a bladder infection get paid?

I believe bladder infection is not reproductive related, but I could be wrong as I think a UTI is not covered. But consider these that are reproductive organ related: negative mammogram, bad pap/HPV, ovary cyst, heavy menstrual cycle, hysterectomy, etc.
 
I believe bladder infection is not reproductive related, but I could be wrong as I think a UTI is not covered. But consider these that are reproductive organ related: negative mammogram, bad pap/HPV, ovary cyst, heavy menstrual cycle, hysterectomy, etc.

Sounds like SAI's health history.

Rick
 
VolAgent said:
Why do you keep airing your wife's dirty laundry like this? :no: You ought to at least get her some earrings and take her out to dinner to say you're sorry.

He did buy me half a boob job. It was very generous of him but also very mean at the same time. I wish I would have had them just give me a boob in the middle instead of being lopsided...
 
senior-advisor-indiana said:
He did buy me half a boob job. It was very generous of him but also very mean at the same time. I wish I would have had them just give me a boob in the middle instead of being lopsided...

I hope you happy, I just blew soda all over the place from that post....Wife is still wondering what has me laughing so hard.
 
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