Undiagnosed Symptoms = Decline

Jun 15, 2007

  1. Alsky
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    Alsky Guru

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    I have a prospect who is in perfect condition, non smoker except that during the middle of last year started complaining about headaches and neck pain.
    Pain and headaches continued and in the beginning of this year his doc had him do an MRI... these results were negative. He has never taken any meds for his pain.

    Since his occupation is an auto mechanic, I would have figured his MD would have suggested that his symptoms could be muscular. Well, his application was ridered for the following:

    ANY INJURY TO, DISEASE, OR DISORDER OF THE CERVICAL SPINAL COLUMN, INCLUDING THE VERTEBRAE, INTER VERTEBRAL DISCS, SURROUNDING LIGAMENTS AND MUSCLES, COMPLICATING RADICULITIS (WITH EXCEPTION OF NEW TRAUMA BY FRACTURE) AND ANY TREATMENT OR OPERATION FOR...

    I have called all the other companies I am appointed with and got the same scenario from each: If there is no diagnosis for his headaches and neck pain, they would decline.

    When I first called the prospect, he told me he had MEGA and that it Su**s! I guess he is going to be stuck with his bad health plan.

    Being relatively new to the health field, I thought I would share this and welcome feedback.

    By the way, I am having some neck pain right now from staring at this laptop... guess I better never mention this to my MD.
     
    Alsky, Jun 15, 2007
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  2. somarco
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    somarco GA Medicare Expert

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    Undiagnosed illness is almost always a decline. Though some will find an argument here, a policy with a rider is preferable to no coverage at all . . . or a policy that is a limited benefit indemnity plan.

    About once a month I get folks on meds for pain that apparently has no definitive cause and no specific diagnosis. Most of the time I have to tell them there are no carriers willing to write their coverage.
     
    somarco, Jun 15, 2007
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  3. zort
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    zort New Member

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    The company I am with accepts everyone. It doesn't matter if they have nothing or Lupus.

    They can get:
    $1000 a day ICU Per Person up to a maximum of 20 days per injury or sickness.

    $500 a day for hospital stay up to a maximum of 30 days per injury or sickness.

    $5000 of accidental medical Insurance with a $100 Deductible for the accidental Medical Insurance.

    $50.00 per Doctor's Office visit.

    $1000 of Insured Dental Benefits per calendar year paid per Dental Schedule of Eligible Expenses ($50 Deductible). The Deductible is waived for 2 cleanings every Year.

    There are quite a few discounted benefits that are included too. Which basicly means they get the pre-contracted rates when they use them.

    The underwriter is the beechstreet network.
    They can get this for $184.95 per month (Individual or Family)

    The Limitations are:
    Pre-existing Conditions Limitation: Benefits are not provided for any loss caused by or resulting from a Pre-existing Condition until the earlier of: (1) the end of a continuous period of 12 months commencing on or after the covered person's effective date of coverage under this plan during all of which the covered person has received no medical advice or treatment in connection with such Pre-existing Condition; or (2) the end of an 18 month period commencing on the covered person's effective date of coverage under this plan. This provision does not apply to newborn or newly adopted children. Pre-existing Condition means a medical condition, injury or sickness, not excluded by name or specific description, for which medical advice, consultation, care diagnosis or treatment was recommended by, or received from, a doctor within 12 months immediately prior to the effective date of coverage for a covered person.


    Exclusions and Limitations: Benefits will not be paid for charges or loss caused by, or resulting from, any of the following: suicide or any intentionally self-inflicted injury; any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of, a doctor (accidental ingestion of a poisonous substance is not excluded.); commission, or attempt to commit, a felony; participation in a riot or insurrection; driving under the influence of a controlled substance, unless administered on the advice of a doctor; driving while intoxicated as determined by the laws in the jurisdiction of the geographical area where the loss occurs; declared or undeclared war or act of war; nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180 days of the initial incident and: the loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and the covered person was within a 25-mile radius of the site of the release either: at the time of the release; or within 24-hours of the start of the release; or occurs while he is in the state where this plan was issued; or treatment of mental or nervous disorders, or alcohol or substance abuse.




    If you would like to be able to offer this to them and make money from it please send me a pm.
     
    zort, Jun 17, 2007
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  4. STIBROKER
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    STIBROKER Like My post and enter the DRAWING,,,, Moderator

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    he would better of with mega......


     
  5. nate124
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    nate124 Guest


    Yikes. First off... if someone goes to ICU, #1, it will cost more than $1,000/day and #2, there is a very good chance they will be there for more than 30 days.

    Secondly, there is a pre-existing clause? This is basically a very expensive accident/discount plan. The fact that it has a waiting period associated with it is just plain rediculous.

    I agree. Better off with Mega. Once again I will say "yikes!".
     
    nate124, Jun 17, 2007
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  6. K-Dub
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    K-Dub Super Genius

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    I know you are new and all but please refrain from soliciting agents or suggesting a limited plan on this message board!! This guy has options, no need to jump on a plan that could bankrupt him in the future.

    Can he start a small group?

    How long was the waiver for? 2 years? Lifetime?

    Is there a state mandated plan?

    I'd get him full coverage for now, then if his situation goes away or stays dormant there is a much better chance of getting him on an individual plans in the next few years.

    Just a thought!

     
    K-Dub, Jun 17, 2007
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  7. K-Dub
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    K-Dub Super Genius

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    What will $500 a day do to a bill like this for room and board?

    Top Line from a hospital bill, 1,411 a day, I'm sure that's on the low end as well! What about the other 29,000 in charges at the hospital?? How does your plan pay for that?
     

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    Last edited: Jun 17, 2007
    K-Dub, Jun 17, 2007
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  8. Alsky
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    Alsky Guru

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    The waiver was for lifetime... client is presently insured with UA... SC has a state pool but he would not be eligible because you cannot cancel coverage to go to the pool.

    I will not pull my prospect from UA to go with a guaranteed issue plan that has little or very limited benefit.

    I advised him to contact his doctor and have his MD update the APS... if he follows through, and his MD shows some type of diagnosis, we may have a shot with the underwriter.

    Group has also been discussed but he is a 1 man show and wife is on a group at work but is too expensive to add him to her group.

    Thanks for all the suggestions.

    Al
     
    Alsky, Jun 18, 2007
    #8