Humana says decline unless...

[padthaiforlunch]

During interview, client tells me was diagnosed with high (210, under 200 is ok) cholesterol a couple years ago. Dr. prescribed pills but client never filled it because he believes side effects of pills are worse than problem.

I call Humana to ask about this. I am told that since he didn't follow recommeded course of action they will decline, unless he goes back to Dr. and gets new course of action.

Since people often do not follow a dr's course of action (stop smoking, exercise more,...) this seems bs.

How do I deal with this, now and in the future?

He is coming off of Mega, and it seems incredible that he is now uninsurable.

I would like to stay with Humana, since they have a very cometitive pricepoint in Colorado.

Thanks.

 

[moonlightandmargaritas]

If the Doc writes a script, and the client doesn't fill/take it, it's always gonna be a problem.

Have him get new labs -- and pray.

 

[somarco]

Since people often do not follow a dr's course of action (stop smoking, exercise more,...) this seems bs

No, it isn't BS.

Same action from ANY carrier.

Your client, and you, do not get to make up your own rules. If your client wants coverage, thru H1 or anyone else, he needs to stop going AMA.

 

[indmedins]

Needs medication control for 6 months or more for H1 to consider with standard to a rate of 10% or higher (at least in FL). Just like somarco said, H1 will consider this case AMA.

They used the higher for my client the other day, 101%. His wife says, boy my husband is expensive. LOL.

 

[Chkndinner14]

Try Assurant, they may have a different take on this.

 

[TXINSURANCE]

In CO I would try Aetna.

Here is the real question - what is this clients cholesterol NOW?

If the client can show good readings due to exercise and diet - I think they will get issued, that is reasonable.

What is not reasonable is not following the doctors instructions or getting checking your cholesterol in 2 years (if this is the case). You can get a cholesterol test for $20 at any grocery store, even our local hospital has free tests once per month.

I guarantee you any carrier is going to want a recent reading - if all checks out, I don't see the issue.

I agree with the clients perspective by the way ONLY if they can back it up with good readings due to lifestyle changes.

 

[padthaiforlunch]

Naturally, I will have him get tested. It just seems that it would be a fairly common occurrence for people to go to the dr. and not necessarily follow the advice given.

So, I was wondering how you guys handle these situations. Not trying to make up my own rules.

As an aside, I was told that if the dr. had not made the prescription, he would face testing and potential rate up, but not the auto decline for not following dr. orders.

Not quite sure what AMA is, but isn't it fairly common?

 

[TXINSURANCE]

Same thing I tell those who "might be pregnant" - go to the doctor and they call me back when you are 100% certain you are not pregnant.

Would you believe they never call back?

Most of the time when a client doesn't follow doctors advice something is way wrong, more so than a little high on the cholesterol.

You can get instant total cholesterol tests just about anywhere, I had one at Sam's Club in 2 minutes - although the labs are 10X more accurate, and distinguishes the good and bad cholesterol.

The client needs to realize the carrier is putting up $5 million (or so) dollars on a few hundred per month - the burden is on the client.

As for your case - I bet it would get issued with Aetna, with or without the lipid panel. Heck worst case he is in CO - put him on a one man group! LOL...

 

[somarco]

Not quite sure what AMA is, but isn't it fairly common?

AMA is against medical advise.

Yes, a lot of people never take their meds, or stop taking them, because they feel fine. While many docs are "pill happy" the meds are scripted for a reason.

I do not know of a single carrier that will accept someone who has gone AMA. It follows the same logic as the universal question "have you been advised to have any tests or treatment that has not been done, or are you waiting on results . . . ".

Carriers I work with will routinely pend, or (most often) decline an applicant if they have not followed doc orders.