UW After Sept 23rd

[Crabcake Johnny]

I'm welcoming thoughts on how the Sept 23rd change regarding carriers not being able to rescind policies will affect underwriting.

After Sept 23rd a review board will be set up by HHS. If a carrier wants to rescind a policy the insured must be notified, then the case goes off to the third party committee.

Policies will only be rescinded when the carrier can prove intent to defraud. So, the person who smokes 2 packs a day yet checks "non smoker" is a no-brainer - clearly intent to defraud.

But that client who forgot to list that med they took 4 years ago? Almost impossible to prove intent. Assurant had a famous battle where a condition was listed in the doctor's notes the client wasn't even aware of. Assurant eventually lost that case. Under the new rules there is no case - rescision denied.

So, will carriers be going to 100% APS?

 

[DS4]

....client who forgot to list that med they took 4 years ago?

Every app I've even seen only asks for Rx's within the past 12 months.
We are already feeling the effects here in California. Post underwriting is a no no. Therefore, the carriers are screening more closely during the underwriting process.
Every app that I have seen that was rescinded was a blatant lie.
I had an app a few years ago where the applicant was approved. Had knee surgery within 2 months of the effective date. The carrier investigated and found out the applicant had 5 recent prior surgeries on the same knee. This was not disclosed on the app.
Of course,Obama would parade this poor rescinded insured around to the public as an example of the evil health insurance empire!

 

[Crabcake Johnny]

I've had 4 rescinded and yes, full chargeback on comp.

 

[DS4]

Back in the 80's, I wrote health insurance through a company called American Western Life. They were declared insolvent in 1997.
I wrote a health insurance policy on a husband/wife. Four days after the policy is approved, the wife is diagnosed with cancer. This was her first visit to this physician that made the diagnosis..
Of course, this all seemed a little fishy to the ins co.
American Western Life requested medical records from the physician. The new patient medical history forms showed this woman to be in perfect health with no prior medical history.
American Western Life, armed with a copy of the "authorization to release medical records", hired a team of investigators. These investigators fanned out and visited every physicians office within a 10 mile radius of this womens home. The investigators were able to find a physician that had diagnosed cancer the previous month prior to approval. The policy was rescinded. Additionally, American Western Life handed this case over to the local DA for prosecution.

 

[HealthGuy]

AL3 never had a policy recinded, but according to you AL, isn't that all that insurance companies do, recind and rape people? Or is it that you work with perfectly ethical people all the time, who are just like you?

 

[somarco]

Carriers have only rescinded policies in the past when they can prove fraud or misrepresentation. Some of those rescissions were successfully challenged, most were not.

Nothing really changed with Obamacrap other than more layers of govt oversight and of course, higher premiums.

I have had 3 apps approved by Humana this week in record time. Something that has not happened since Barry was elected. No APS even though there were medical conditions (nothing major) on the app.

In addition to the app, most use MIB, an Rx database (such as IntelliScripts) and a phone interview.

I have had a few encounters with post-issue underwriting, mostly from Humana, but every one of them found nothing and the claim was paid.

I have only had one rescission in the last 4 years and the lady did not challenge it.

Going forward I don't expect more APS' although that is certainly a possibility.

Humana is going to introduce more flexible underwriting in GA in a couple of weeks. They have followed Time's lead and will be using CSD's. Apparently they already do this in a handful of states.

Overall, I am seeing more declines than normal and expect this to continue. Much easier to say no than go through the hassle and expense of an APS.

 

[ABC]

I don't foresee the APS being used anymore than what it is now. What I do think will happen is pyramid exams will become standard.


I have had one policy rescinded in my 10+ years of selling.
The premium was returned to the client and claims were denied. The comp was also taken back.
It was a legit rescind. The primary did not list all of the conditions on the dependent. So 9 months later when the dependent files a claim the insurance company asked for medical records.

 

[Crabcake Johnny]

Can only Egyptians conduct pyramid exams? Do prospects have to fly to Giza?

 

[arnguy]

Can only Egyptians conduct pyramid exams? Do prospects have to fly to Giza?

I think you mean Gaza, John. The answer is that they must be approved by Israel before they can fly to Gaza.

 

[Crabcake Johnny]

Great Pyramid of Giza - Wikipedia, the free encyclopedia

Giza - Wikipedia, the free encyclopedia

Giza is in Egypt - Gaza is in Israel. The pyramids are in Giza, not Gaza.