Whats Going on with Humana One ?

[somarco]

I think I have had 3 claims reviewed by H1 in the last 4 yrs or so since I started writing with them.

One was minor and was denied (properly so).

The other 2 were major claims. Took 3 - 4 months, mostly waiting on doc to respond, then a review by the medical staff.

Paid.

Both in xs of $150,000.

 

[InsureMonkeyQA]

It's nice that Humana 1 that the apps are approved so quickly - but I have to make very sure everything in the app is right or else the client will be at the whims of post issue underwriting.

Their phone app is really neat - but a lot of older clients I have waiting for Medicare plainly don't trust it, especially when explaining what an e-signature is. I like how fast it is, but if they don't report anything or forget... well they'll hopefully not have to face a 20k bill.

 

[STIBROKER]

man.....they are on a roll today........2 issued in under 20 min's as applied for........

 

[shepnerd]

man.....they are on a roll today........2 issued in under 20 min's as applied for........

They do some that get auto accepted or rejected based on the app. They dont even pull an MIB.

They are trying to get up to 80% MLR from their current 65% so they dont have to do rebates. They are gonna be pretty darn competitive for a bit I think...

 

[STIBROKER]

They do some that get auto accepted or rejected based on the app. They dont even pull an MIB.

They are trying to get up to 80% MLR from their current 65% so they dont have to do rebates. They are gonna be pretty darn competitive for a bit I think...

Ended up with 3 issued....one with a specific...RX rider....all phone in...all issued in 20 min's.....

 

[ksigmtsu]

Yeah, but what they're doing is auto-issuing and then if they see a claim, they attempt to underwrite post issue and void the policy, so you're literally risking selling someone a policy that will not pay their claims.

They termed my contract for advising a client to fight them when they tried to rescind her policy to get out of a 40000+ dollar claim.

I wouldn't place business with a carrier when I knew it was a serious risk they might do that to them, and if they did they would refuse to pay all future owed commissions, and change the AOR on all policies against their contract so in the future they wouldn't have a problem with an agent doing their job.

They do not follow their contract in case of termination of agent. They will term you for doing your job and not playing ball.

If you can sleep at night knowing that's what you're doing..

 

[Crabcake Johnny]

Post claims UW is dead. Went bye bye per PPACA. Now the only way a policy can be rescinded if it the carrier can prove that the client had intent to commit fraud.

Not only that, but the insured must receive a 30 day notice from the carrier on their intent to rescind coverage which is also subject to an independent review.

 

[somarco]

Post claim issue has been illegal in most states for some time, predating Obamneycrap.

Post issue underwriting is something different . . . even if you consider it semantics.

Rescissions can still be done but not retroactively as they were before Obamneycrap. That will make carriers a bit more reluctant to issue without checking the resources.

It also has had an impact on rates.

I don't know how you would know if a carrier checked MIB or not, but I doubt that comment. MIB checks are instantaneous and show a hit or not. Rx histories are also verified but only take a few moments.

 

[Crabcake Johnny]

I believe one carrier testified before Congress that rescissions accounted for one quarter of 1% of all issued policies.

 

[ksigmtsu]

Post claims UW is dead. Went bye bye per PPACA. Now the only way a policy can be rescinded if it the carrier can prove that the client had intent to commit fraud.

Not only that, but the insured must receive a 30 day notice from the carrier on their intent to rescind coverage which is also subject to an independent review.

No less than 6 months ago, Humana did EXACTLY that to a client of mine, tried to post issue UW after a major knee surgery they pre-approved, tried to claim fraud on the client and myself, and dropped the claim after involvement of the DOI, and Senator Bob Corkers office.

State of TN DOI said they had a ton of cases like this in the last year involving Humana. You should call my DOI and ask them about it.

Humana then termed me not for cause, on 30 day opt out, and immediately breeched contract, changed all AORs, and refused to pay any future commissions even though I was termed not for cause.

Health Choice One claimed they would get them moved under them in house and continue to pay me, haven't received 1 penny or 1 piece of communication. The Humana rep confirmed they were moving everyone under HCO.

Humana owes me on about 50 clients for health/medicare they stopped paying, and moved in house because I wouldn't play ball and help them term a 64 year old that did nothing wrong. Their contract states clearly they can't change the AOR or stop paying in a case of termination by 30 day opt out at the carriers choice.

Their reason they were threatening to rescind her policy was that she failed to report a doctor suggesting she take vitamins 5 years prior on her application. She claims to not remember the conversation.

You can claim it doesn't happen, I have a STACK of letters and emails proving it does.

Again, if you play with Humana, you're exposing yourself and your clients to this.

The scarier part, they stop paying 100% of commissions and steal all your clients at any point they choose by sending you a letter saying they decided to stop contracting you, 30 days later, they move everyone in house and stop paying.

You sell for Humana, you're exposing yourself to risk that in 2 years they do that to everyone, and your recourse is a lawsuit when they breech your contract.