Met with a new client today

[Colorado Newbie]

Early this morning I received a lead. I called her and it turns out she has not had insurance for 5 years. She wanted to sign up right there on the phone but I asked her if we could meet in person to do this. She was a bit reluctant but caved in. So we decided to meet at a local Starbucks to help her with her insurance needs. I arrived a few minutes late and she was already there. We sat together and we ended up going with a policy from GR. I signed her up right there via my laptop/wireless internet. When it came time to leave I could tell she was reluctant to get up for some reason. So I told her I had to go to the bathroom and said my goodbyes to her. I got up and went around the corner and waited for her to get up and leave. Well my 30 year old lady with 2 kids had a limp you would not believe! Truth be told it was more of a waddle like a duck with a broken leg. (and no, I don't think she pooped her pants)

Anyhow, I really feel like I have been had and I am tempted to call GR underwriting. Oh the hell with that. I will call GR. I don't want any more charge backs!

 

[J.R.]

Early this morning I received a lead. I called her and it turns out she has not had insurance for 5 years. She wanted to sign up right there on the phone but I asked her if we could meet in person to do this. She was a bit reluctant but caved in. So we decided to meet at a local Starbucks to help her with her insurance needs. I arrived a few minutes late and she was already there. We sat together and we ended up going with a policy from GR. I signed her up right there via my laptop/wireless internet. When it came time to leave I could tell she was reluctant to get up for some reason. So I told her I had to go to the bathroom and said my goodbyes to her. I got up and went around the corner and waited for her to get up and leave. Well my 30 year old lady with 2 kids had a limp you would not believe! Truth be told it was more of a waddle like a duck with a broken leg. (and no, I don't think she pooped her pants)

Anyhow, I really feel like I have been had and I am tempted to call GR underwriting. Oh the hell with that. I will call GR. I don't want any more charge backs!

Are you explaining the claims review process to people and did you confront the woman about the limp?

 

[Crabcake Johnny]

"Early this morning I received a lead. I called her and it turns out she has not had insurance for 5 years."

which is everything you needed to know to dump her off right then and there

 

[Guest]

Well my 30 year old lady with 2 kids had a limp you would not believe!

Excuse me but where and when did you get your medical degree? You don't know what is wrong with her. She might be perfectly healthy but with a birth defect. You did the right thing by taking the application.

Unless you are absolutely sure she is trying to defraud the company you are best advised to not use the 'fraud' word to GR. You have no evidence except that she limps. If you want to send a note to GR that you saw her walk with a limp, I understand. But for you to be judge and jury and decide that she is trying to defraud the company is way beyond the pale.

Maybe the reason she didn't want to go is because she is self-conscious about how she walks and didn't want you to see her. Maybe she thought that you would assume exactly what you did... that she is fraudster or that she has a pre-ex.

As an aside, I'm always on the side of the client and not the carrier unless there is not a scintilla of reasonable doubt that what the client is doing is fraud. I'm a client-advocate... not a company man. It's a good day for me when I get to take on some snot-nosed, salaried, underwriter drone or claims examiner because they had a fight with their spouse this morning and are going to take it out on the world via their big red "decline" rubber stamp. I'm not the one they want to %$#@ with:

Have Pen Will Travel reads the card of a man.
A rep without armor in the health care land.
His fast pen for hire head's the calling wind.
An agent for clients is the man called A. Cantin.​

(A little poetic license with spelling. YMMV. For those too young... see this.)

Al

 

[Crabcake Johnny]

If it was a birth defect it would still have needed to go on the app. Any condition that's present, even if has not been treated in years has to go on the app.

Say someone was born with a very mild case of Spina Bifida, got some treatment for a year but is now 32 and hasn't received treatment for 31 years. It's on the app since the condition is still present.

 

[Mr. Bill]

Have Pen Will Travel reads the card of a man.​

A rep without armor in the health care land. ​

His fast pen for hire head's the calling wind.​

An agent for clients is the man called A. Cantin.​

(A little poetic license with spelling. YMMV. For those too young... see this.)

Al

Whew - I skimmed over that part way too fast, just saw "wind" and thought I saw "Clinton" and I think my dog farted, which just made the whole thing make sense.

You did the right thing by taking the app, and you might want to open the door with a "is that a permanent or temporary limp I noticed" type of question and see how she responds. You're absolutely right in protecting yourself - it's not about the insurance company. Good luck!

 

[Colorado Newbie]

Excuse me but where and when did you get your medical degree? You don't know what is wrong with her. She might be perfectly healthy but with a birth defect. You did the right thing by taking the application.

Unless you are absolutely sure she is trying to defraud the company you are best advised to not use the 'fraud' word to GR. You have no evidence except that she limps. If you want to send a note to GR that you saw her walk with a limp, I understand. But for you to be judge and jury and decide that she is trying to defraud the company is way beyond the pale.

Maybe the reason she didn't want to go is because she is self-conscious about how she walks and didn't want you to see her. Maybe she thought that you would assume exactly what you did... that she is fraudster or that she has a pre-ex.

As an aside, I'm always on the side of the client and not the carrier unless there is not a scintilla of reasonable doubt that what the client is doing is fraud. I'm a client-advocate... not a company man. It's a good day for me when I get to take on some snot-nosed, salaried, underwriter drone or claims examiner because they had a fight with their spouse this morning and are going to take it out on the world via their big red "decline" rubber stamp. I'm not the one they want to %$#@ with:

Have Pen Will Travel reads the card of a man.
A rep without armor in the health care land.
His fast pen for hire head's the calling wind.
An agent for clients is the man called A. Cantin.​

(A little poetic license with spelling. YMMV. For those too young... see this.)

Al

I knew there was a reason I posted this. You are correct.

Thank you

 

[J.R.]

If it was a birth defect it would still have needed to go on the app. Any condition that's present, even if has not been treated in years has to go on the app.

Say someone was born with a very mild case of Spina Bifida, got some treatment for a year but is now 32 and hasn't received treatment for 31 years. It's on the app since the condition is still present.

Correct me if I'm wrong, but why would that example need to go on the application if the individual had not received treatment for 31 years? That is well past the usual 5-7 year requirements for most pre-existing conditions and would be case specific.

 

[taterpeeler]

i agree with u sal.... why on the app.... ???

 

[djs]

Hmm, maybe she just went to the gym and worked out to hard and was stiff, or maybe she stubbed her toe in the morning, neither of which are that notable, though both can make you limp.

Maybe her leg fell asleep from sitting to long.

Maybe she was playing with her kids.

Maybe she has a serious problem and has been treated for the last 10 years.

Truth is, nobody (but her) knows. If its something serious, the underwriter will see it. If you call, they will order medical records, which will delay, perhaps prevent, coverage.

This is why I hate health insurance, give me a nice clean auto policy any day Okay, I'm off to write 3 health policies :( Ooops, commission is good though

Dan