Post Issue Underwriting

So what the heck is post issue underwriting?

Glad you asked.

That’s when you apply for coverage, the policy is issued. Then at some point in the future, usually following a claim, you get a letter from the health insurance carrier. They want to know all doctors you have seen in the last 5 years and all medications you have taken.

The envelope has a form you are to sign, allowing them to contact the doctors and obtain medical records.

Welcome to post issue underwriting.

You submitted an application. Probably went through a recorded telephone interview. They pulled your medical records (such as they are) from MIB and may have checked your prescription drug history with someone like Milliman Intelliscript.

You passed with flying colors.

Or did you?

Your claim may have been for a persistent cough or a nagging pain in your back. Or it may have been something as simple as your annual exam.

The next thing you know, they’re baaacckk . . .

What are they looking for?

Something you purposely, or even carelessly omitted in your medical history. Something so minor to you, it was probably dismissed or forgotten.

They are looking for a reason to deny your claim or even rescind your policy retroactively to the effective date.

Can they do that?

You bet.

If they can prove you withheld material information about your health you are out of luck.

That’s the bad news.

But here is the good news.

If you used an agent who knows the business. Understands how carriers think and what they look for, then (her comes the shameless plug) you are in good hands. I have worked with carriers for over 30 years. Who knows better how they think and what they will do than someone who has actually been on the inside and walked the halls of the home office?

I do a lot of things to diminish the possibility of post issue underwriting. Things like anonymous pre-screening a clients health history with potential carriers before submitting an application. We also do a trial run on every application. Even though all carriers accept (and prefer) electronic apps, we do a practice run on a paper app before ever submitting to the carrier. I review each application with my client, alerting them to potential issues and tell them what to expect during the phone interview.

I don’t like surprises and I assume my clients don’t either. Clients are never alone when I am hired to be their agent and advisor.

If you need your claim paid, would you rather fight the carrier’s on your own or have a professional “hit man” on your side?

The choice is yours.

Georgia health insurance can be tricky. Finding the right plan is only part of the battle. The real challenge comes the first time you file a claim.

A test of a policy is not in the obvious benefits, but rather what it does NOT pay.

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