Wednesday, February 28, 2007

Double Secret PHI

This could just as well be titled Stupid Carrier Tricks #73 but I opted for more of the Animal House theme instead.

Here's the deal.

Sent an application for individual health insurance to a carrier that (for now at least) will remain Nameless. The guy is a little chubby, about 10# over the limit for standard issue. Takes meds for cholesterol. Has borderline hypertension but the doc has not put him on meds yet. Had a bout with stress about 6 months ago. His doc prescribes medicine for anxiety. After 30 days the stressful issue is resolved, he stops the med with docs approval.

About 3 weeks after submitting the app, Nameless Insurance Company (NIC) declines to issue coverage.

Letter to the applicant to follow.

Being the wonderful agent that I am, I call my contact at NIC to inquire. I am told he was declined due to weight + HBP + cholesterol.

I call my client.

He reads me the letter which states he was declined due to "psychiatric history".

Now I look like a fool.

So I go back to the carrier asking a simple (and obvious) question. Which is it? His weight + blood issues or psych?

Later I discover a message from an underwriter is left on my voice mail. "We can't tell you because of PHI (protected health information) but what we can say is he was declined for reasons OTHER THAN (emphasis mine) weight, HBP, cholesterol or psych".

Oh really?

So . . . you can't tell me why he was declined because of PHI.

Can you explain why you can't tell the applicant either?

They are supposed to get back with me on that.

Just look for the blue guy. He is the one holding his breath . . .
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