Consult, or take the order?

somarco

GA Medicare Expert
5000 Post Club
36,848
Atlanta
A guy called this week looking for health insurance. I took down his information and learned his wife has "some kind of heart condition" where her heart beats erratically. Doc told her it was nothing to worry about. Probably 80% of the population has it.

After talking to the wife, and getting her to call the doc, I found out she has PSVT.

He put her on Toprol-XL 5 years ago.

She is a smoker.

I told him this may be a problem but I would look into it.

He told me it was never a problem in the past.

OK, so do you want me to help or not?

Sure, send me some numbers.

I emailed several carriers and here is what I got.

Aetna - probable 50% rate up
Blue - decline or 40% rate up + 3 yr waiver on the heart
GR - decline or waiver for arrhythmia
Humana - full cardio waiver
KP - 40% rate up or decline
Time - decline

I suggested he look at Aetna plans & factor in a 50% rate up.

He went ballistic. Told me Blue & Aetna had no problem with her in the past.

His coverage runs out on 10/31. Blue will take 2 - 3 months to underwrite and probably decline.

Aetna might be able to complete the underwriting in a few days if they don't order an APS.

He told me he was going with Blue because they covered her in the past.

Sure. In the past they would take diabetics but no longer.

I gave him my link to Blue and told him to call me if he wants to look at Aetna.

Makes me wonder why I even try to help. Probably should have just given him my link to Blue and sent him on his way.

Problem is, that is a no win situation.

If I don't say anything he get's pissed when it takes so long to get an answer.

If I tell him what to expect he wants to argue and tell me Blue took her before, no problem.

Can't win on that one.
 
This is one of those cases where you will be proven correct, but later. We've all been there, where we think someone has ran up the bill to make more money, only to find out later that they actually knew what they were talking about.

It's kinda like the guy who quotes you $1000 to fix your car. After you pick yourself up off the floor, you go elsewhere, they quote you $500. They start the work, and tack on another $700 to actually complete the job, because they finally figured out what the first guy knew.

You can't win this. Save yourself the time. Call him in 3 months, and hope Aetna will still take them.

Dan
 
Honestly I can't imagine any carrier would take this case, but there are some state and carrier variations.

She has PSVT and is a smoker??? Come on now - she is clearly NOT playing along. I get these calls all the time the smoker with COPD, Asthma - bottom line is at some point you have to take personal responsibility for your health situation.

I would suggest group, cobra, hipaa or risk pool depending on your state. This client is clearly of risk and should not be mixed with gen pop, but this varies on the state.

I would have flat out told the client - she needs to quit smoking with her risk items. Her doctor won't tell her. Her family won't tell her. She won't tell herself - someone needs to step up to the plate and call it what it is - smoking and heart problems don't mix - sorry she is causing her own problems.

But to answer your question YES you are doing the right thing TRYING to help - and if it doesn't work, you tried your best. That is all we can do anyhow.
 
"But to answer your question YES you are doing the right thing TRYING to help - and if it doesn't work, you tried your best. That is all we can do anyhow."

You also have to remember it is easier for them to yell and be mad at you, rather then the true culprit...themselves. In this business you will take alot of crap for being honest with people about their conditions. They get mad at you, but they know you're right, they just are mad.

Depending on the person, you either say thanks and bye or you hang around a bit when things sort out a bit and the realize you are trying to help.

It's the irony of this profession that people blame you for what they've been doing for 20 years to themselves.
 
What bugs me most is this.

He installs fences. Probably good at it. Been doing it for 10 years.

I find health insurance. Been doing it for 33 years.

I think I am pretty good at it too.

Much better at this than building fences.
 
I would estimate 90% of the health issues I encounter are LIFESTYLE and / or diet related. I don't see how in 10 years half our population needs designer mental drugs, ED drugs, of 80% of the other drugs on the market.

ADD / ADHD - I didn't pay attention at school as child, because the format of the education was improper, boring, and I was a kid - but it would be a cold day in you know where before my parents medicated me. Most of the ADD / ADHD is diet related - I had home cooked meals EVERY DAY at my home - very little pre packaged or processed junk. We had REAL food and REAL nutrition, I miss mom's cooking - but that's another thread...

Another Example - my HDL was 20 points high because I pigged out a little last holiday. OK nothing a few crunches and some GNC high potency fish oil didn't cure in 3 months - wow what a miracle! My doctor wanted to give me Lipitor - don't get me started on the side effects of statins....

I bet my doctor I could get my HDL better on my own in 3 months, and I did... Now some people have bad roll of the dice or hereditary issues - this is NOT what I am referring to at all. My mom had early onset Parkinson's at 40 - it is highly unlikely she did anything to bring that on herself, the reason she got it is way over our head and current understanding of the the disease.

I had a 20 year old 5'2 298lbs call our office looking for insurance and was upset everyone declined her she said she is and I quote "a little overweight but in perfect health" - I didn't have the heart to tell her 5'2 298 is not a little over weight and it is physically impossible to be healthy at this BMI - long term.

We don't apologize or let customers drag us into this "feel sorry for me" mode we politely tell them you CAN get insurance through GROUP or our state's outstanding risk pool. The worst thing you can do is get dragged into this "the man is out to get me" conversation and anti-capitalism rant of the consumer. Kill them with kindness and offer them group or risk pool (or whatever your state has). We even go as far as to email them the risk pool rates and forms but they don't appreciate it.
 
Call me an ***hole, but I would not let people mouth at me when I know I'm right. As you mentioned, he's been building fences for 10 years, and you've been doing insurance for 33. I would remind him of just that. I'ld simply say, "Mr. Smith, I've been in the insurance business three times as long as you've been building fences, and I'm not going to tell you how to dig post holes if I hired you to put up a fence in my yard. I've researched this and I've shown you options. If you know of an agent offering better solutions, than by all means go see him. If not, I'm here to help all I can."
 
I've researched this and I've shown you options. If you know of an agent offering better solutions, than by all means go see him. If not, I'm here to help all I can.

I just printed this paragraph out to tape to my desk this week - well said.
 
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