Waivers from GR, what to do?

[Crabcake Johnny]

You can say anything you want. This is a cardiologist bill from one of my clients. If this would have been a GR deal with a rider for HBP and the doctor linked the visit to HBP she'd be looking at a $2,123 bill.....for one inpatient office visit. She paid a $40 copay with Aetna.

So now that well-contolled HBP isn't so well-controlled anymore. Just the cardiologist billed over $300 for the visit.

Go ahead and take out your crystal ball and tell the client outpatient treatment isn't expensive.

But don't worry everyone....this won't happen to any of your clients.

 

[somarco]

Gee, John. Looks like all those years of dealing with carriers, underwriters, reinsurers, claims departments & home office legal staff has been a waste. All I need to do is ask you for all the answers.

I'll try and remember that next time I have a prospect who is in less than perfect health.

 

[Crabcake Johnny]

All I'm trying to say is no one has a crystal ball and our job is to protect people from unexpected MAJOR claims. The word in that sentence to pay attention to is "unexpected"

You can run all the math in the world for just run-of-the-mill HPB care; regular doctor visit for about $60 and one med for about $50.

However, clients need to be made aware that when circumstances change....client with HBP puts on 40 more pounds, that 120/90 "well controlled" reading is now 155/95 and now he "thinks" he has chest pains it all goes south on your scenario.

Off to see a specalist....after all, he has insurance. No he doesn't. He has a rider. Outpatient lab testing that's heart related is thousands. Specalists can charge over $500 just for a visit.

Again, I protect my clients against the possibility of large future claims....not their current state of health.

I'd guess my client on Aetna was certainly happy with my recommendation - $40 copay for $2,000 worth of charges. Had I recommended GR with a rider that client could have been ass out.

Maybe your client's health never changes. You must be very lucky. I'll also remind you there are outpatient heart procedures that are $15,000+.

You sell however you want to sell. I sleep well know that whatever comes my client's way, they have full coverage for it. I never EVER have my clients sign riders for on-going conditions.

So Somarco, do you explain to your clients that the situation exists where they could be responsible for untold thousands of dollars? Or is it just easier to tell them to sign the rider.

But again, I'm not getting into it. I'm sure GR appreciates the signed riders. I think trying to tell your clients that nothing horrible in the future will happen is a "mega life" mentality.

 

[SME]

On the original question I would go with Aetna on this one. Although Humana has been surprising me lately with what they will take. Aetna doesn't put a rider on and the UW can be easier on her. Because of the GR rider she will have to disclose this on the app and they will probably request an MIB report and possibly medical records to see why there was a rider which will slow underwriting beyond the 20 day free look. It's a sticky situation. Does she have current coverage?

 

[somarco]

Aetna does not use MIB . . .

20 day free look does not apply in all states.

 

[trvlnut]

She has high cholesterol too

Well I just spoke with my client and she indeed has high cholesterol and was on high cholesterol meds a few months prior to applying for insurance. I don't think she left it off purposely. She doesn't speak english very well so it's possible that she didn't understand the question about high cholesterol when asked. Anyway, when GR asked for a hbp form to be filled out by her doc, it must have shown her high cholesterol readings. She is now back on the cholesterol medication.

Steph-
She doesn't have any coverage right now. I am inclined to suggest she keep the policy and then try to get her another policy with an up-rate. I spoke with Assurant and they will up-rate 50%. From what you said, Aetna will do the same.

Her husband has issues too. He only qualifies for a portability plan. I initially recommended the BCBS Preferred Basic plan, but you have to fulfill the deduct before anything is paid for to see a specialist. He only sees his GP and that is covered under a copay. After reading John's post, I'm questioning my suggestion.

 

[somarco]

I am inclined to suggest she keep the policy and then try to get her another policy with an up-rate.

but . . .

she does qualify for a portability plan now, but if she accepts this coverage and Aetna doesn't take her, then she's stuck in this plan.

Just a suggestion.

Put her on a HIPAA plan THEN try to get something different. Otherwise both of you may be screwed.

 

[Crabcake Johnny]

Riders are for fully recovered medical events that pose little to no liability. A broken ankle would be an example. Riders are not for on-going medical issues and my recommentation is get her off GR as quick as you can and put her onto Aetna or Assurant. The most expensive on-going medical expenses when health goes south is outpatient treatment - specialists visits, medication and testing. There are also outpatient procedures that are very expensive.

It's not about the rate. Research buying patterns. No one has the cheapest anything - if so we'd all be living in double-wides and driving Kia's. It's about value and in this case it's about potential liability.

Client's are supposed to be short-sighted - not agents.

 

[bluemarlin08]

Thank you John, that is very usefull info. I don't claim to know all I need, and it is blessing to hear this type of valuable info.

 

[Crabcake Johnny]

Think about it this way, the underwriters at GR when they rider something like HBP are basically saying "for this price we can't risk the potential claims." Ok....so your client's supposed to risk it? Now, in all fairness to GR they choose not to rate-increase so their underwriting is limited, but that's not my client's problem.

Insurance is for the insured, not for the insurance company. This is why I simply hate riders even as a concept. It's the insurance company giving themselves insurance - leaving the client exposed to claims. Sometimes it is what is is. But not after all other avenues have been exhausted.