Osteopenia / Osteoperosis

ajtour42

Expert
33
And for my next trick . . .

I shall try to find coverage for a 51 year old woman who has borderline osteopenia (the more minor form of osteoperosis). Her doctor gave her a prescription in 2004, she filled it once, and hasn't taken anything since. The doctor told her she could either take the drug or make healthy diet changes (calcium, fish oils, etc.). "No further treatment."

American Community ridered it. The client is an occupational therapist and knows fully well that ridering osteopenia means ridering anything to do with your bone structure. So, should she break her arm next year, it's likely it won't be covered.

I'm about to do some homework with a variety of underwriting guidelines and phone calls, but does anyone know off the top of their heads of a carrier who will rate up ostepenia/osteoperosis and not rider it?

Many thanks in advance!
 
If it has not been treated in 3 yrs with many carriers it is a non-issue.

I found some who will rider, some at standard (based on your information) and some who will surcharge the insured.

There is no such thing as a borderline diagnosis. A doc will not tell a woman she is borderline pregnant. Either she is or she isn't.

Your client either has osteopenia or she doesn't.

When was the last time she had a bone scan to see if her condition has progressed?
 
Not sure about the bone scan, but I called several carriers today and got the following answers:

Aetna determines the rating based on severity. So, depending on the age of the client, whether they take one or more medications, and whether they've had broken bones in the recent past, they'll either be an A, B, or C rating. From what the underwriter described, this client will qualify as an A!

Medical Mutual of Ohio doesn't rider at all. There will be a rating . . . TBD when I run the quote.

Assurant (as noted in another post) couldn't give me a straight answer. The rep basically said, "Well, just go ahead and put the application through and we'll see what happens." That's not a valid answer, IMHO.

Anyway, thanks for your tips. Hopefully, we'll get this knocked out through Aetna!
 
Assurant (as noted in another post) couldn't give me a straight answer. The rep basically said, "Well, just go ahead and put the application through and we'll see what happens." That's not a valid answer, IMHO.

That's kinda funny, I called Assurant yesterday to inquire about a condition for a prospect that got declined by Aetna. I was told the same thing! I have respect for Assurant but wonder if they are starting to hire former Ehealth CSR's - just put in the app's and see what sticks.
 
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