Thursday, July 06, 2006


I have received a reply from my correspondent, explaining the circumstances and issues.
Turns out, an application for health insurance was recently turned down because of discrepancies between the app and the medical records. Apparently, the applicant’s physician had included several health-related problems in the records, none of which were applicable. Some of these were quite serious (COPD, for example, and hypertension). All told, there were 10 such discrepancies [ed: no wonder the app was declined!].
So, after reviewing all the “problems,” my e-friend met with the doctor, discussed all the items, and agreed that they needed to be corrected. Subsequently, the doctor documented this for his patient, and this letter was forwarded to the insurer. At this point, no word has been received from the carrier as to whether or not this will affect its earlier verdict.
But that’s not the end of it. My e-friend is concerned that the declination has been reported to the afore-mentioned MIB, and will become a permanent source of problems for future insurance applications. For now, COBRA is in place, so there is at least a safety-net in place during this process.
Okay, so what’s my role in this?
Along with Bob, I spend some time each day helping folks at an insurance-related consumer bulletin board. My e-friend read some of my posts, and thought that I might be of help straightening out this mess, or at least supplying helpful directions.
Which I have done.
I explained that the MIB has an appeals/corrections process, which consists of writing them a letter and waiting for a reply. I suggested that such a letter be sent, along with a notarized list of corrections provided by the doc. I also suggested a follow-up phone call, and posited that this will not be a speedy process. Lastly, I suggested that the whole bundle be sent in such a way that it could be tracked, and with a way to confirm delivery (signature, etc).
The next piece of advice was to avoid the initial carrier altogether (for a number of reasons, none of them really relevant here), and to seek the counsel of a professional, independent agent with a minimum of 5 years experience in the health insurance field. Since I have the privilege of knowing quite a few “good guys” all around this great land of ours, I offered to help find one if necessary.
Finally, I suggested that it’s not always necessary (or even desirable) to keep an entire family on one’s COBRA. Sometimes, it’s better to “spin off” other family members to a separate policy. Again, a pro will be able to help determine this.
At the very least, this is an interesting experience. It’s nice to be able to help out, and it’s also nice to have the opportunity to learn more about agencies like the MIB. In fact, Bob sent me a gaggle of links on this subject, which I’m starting to go through even now.
As my correspondent has promised to keep me posted on any progress, I’ll pledge the same to you.
UPDATE: Have you ever heard the term "Common Knowledge?" That's where everyone just knows that such-and-such is true, or that so-and-so is a genious, or whatever, but then it turns out not to be true at all?
Well, like many of you, I just "knew" that MIB is notified whenever a company turns someone down.
Turns out, that's just "CK:"
From: MIB Info Line []
Subject: RE: Declinations
An MIB Report does not indicate the amount of coverage applied for or if a policy was issued, declined or charged an extra premium.
Interesting, no?
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