Recently, I had occasion to speak with a client who was unhappy with his coverage [ed: nooo! really?!]. This gentleman owns his own business, and has had a policy with Company F for a number of years. The plan has a high deductible, and no frills. It covers this gentleman and his family for a little over $900 per quarter.
He called me a few months ago to see if there was anything we could do to lower his premium without lowering his benefits. I looked around, and found nothing that would do accomplish his stated goal. He was not happy with this report, but there was nothing I could do about that. The quotes are the quotes.
Last week, he called me back to complain that he had been declined for health insurance. Excuse me? It seems that he had contacted (or been contacted by) another agent, not affiliated with our agency, but who also represented Company F. This agent told the client that Company F offered a plan with benefits he did not currently have, at a lower premium. The client applied for this new plan, and was declined by Company F due to his elevated blood pressure [ed: on its face, this seems an unlikely reason for declination, but inasmuch as I had nothing to do with this application, I’ll never know the true reason].
The client was outraged, so naturally he called me. Or rather, he had his wife call me. I spoke with her, and then did a little more poking around (I realized at the time that this would most likely be a waste of my time, but one does try to accommodate one’s clients). Again, I found nothing that would maintain or improve his coverage without an increase in premium,. In fact, I ran the numbers with Company F (his current carrier) -- the plan which the other agent had touted as a significant increase in benefits and decrease in premiums – and it actually cost over $2,500 per quarter, and that assumed a preferred rate classification.
As you may imagine, this did not go over well with the client. According to his doctor, his blood pressure was fine, and he was in exceedingly good health.
Now, it may be that the doctor was lying.
It may also be that the insurance company was mistaken.
But what is more likely is that they were both right: The physician sees a patient, about whom he cares, and whose health he is reasonably certain can be managed with (presumably) a minimum of hassle. He sees no major or imminent problems, and because he knows the patient on a personal level, is confident that things will “be fine.”
The insurers, OTOH, sees a potential claim. The company doesn’t know this client on a personal level – whether or not he is a current insured notwithstanding – and assesses the risks of insuring him based on the experience of insuring thousands of others like him.
It’s nothing personal.
One other possibility . . .
ReplyDeleteThe carrier refused this individual on the basis they already had him insured. Some carriers will deny an application for non-health related issues when they are covered now. This is not out of respect for the current agent as it is they dont want to incur the cost of new underwriting, higher commissions (to the new agent), etc.
Reminds me of a recent prospective client who called me looking for health insurance. "Are you healthy?", I asked.
Caller, "Yes, I am".
Me, "Great, are you taking any medications"?
Caller, "Yes (list of meds including steroids follow)".
Out of curiousity I ask about what the meds are for.
Caller, "Just part of my cancer treatment . . ."
Me, "You said you were healthy".
Caller, "Oh, I feel great. I am no longer on chemo and the meds are just a precaution".
Me, "When was your cancer diagnosed"?
Caller, "Last August. All the tests since then have been negative".
At this point rather than go into a lengthy explanation of what a medical definition of "cure" is, I simply ask they call me back in about 5 years. Then I MAY be able to find someone to issue a policy.
Actually, I do have a carrier that MIGHT take this person, but wont cover their cancer for at least 3 years . . .
But I opted to not go there . . .
Bob Vineyard, CLU
I hear ya!
ReplyDeleteOn the one hand, this person may well "feel fine," may, in fact, be in remission or even "cured."
It's the fine line we walk when we work for the client and/but represent the carrier. And underwiritng guidelines regarding cancer are immutable and unbending.
And often, it's heartbreaking to have to tell a prospective client this. Look, they're at least *trying* to obtain coverage, which is a good thing. But OTOH, we don't make the rules, we're just bound by them.
I have less sympathy for my erstwhile client who -- disdaining my counsel -- sought help from someone he did not know, and who may not have a real handle on this (often tricky) biz, and then complains to *me* when he doesn't get his way.
Okay, enough pity party.