Your feedback on how you would manage this substandard case

Posted by Jack Cotlar, M.D. on Sun, Mar 09, 2014 @ 05:32 PM

Substandard case managementCASE: 66 y/o man who had applied for life insurance; was unhappy when he got a moderate rating for life insurance, as “there is nothing significantly wrong with me. I feel fine”. After you (as a consulting underwriter) review of the medical records you find that the medial problems are increased build, coronary artery disease (s/p mi and stent placement in 2008), hypertension, LVH, diabetes mellitus – type 2 (+ neuropathy) and sleep apnea / cpap and that the medical records often cite compliance issues. Assuming you had reviewed the records and felt that the underwriting decision was appropriate and even generous, what are some things you might do to get the case issued and why this path? As a producer whose underwriting staff reviewed the records and arrived at the same conclusion, what path might you take? Feedback please on how you would manage this case …..

 
Dr. M. Jack Cotlar, President
Strategic Medical Consulting, Inc.®
Voice: 317.536.2603 (ET)
Email: jcotlar@strategicmedconsulting.com

Important Notice:

The opinions and examples contained in this article are those of Strategic Medical Consulting, Inc. (SMC). As each case is fact sensitive, it would be ill-advised to take action on any given case based on the conclusions from examples that are included in this communication. Whether or not they are appropriate for a specific medical underwriting situation must be determined by the producer who will assume all responsibility should the outcome not be favorable. The examples illustrated herein are what SMC provides on a case-by-case basis for and to its clients. In addition, the opinions are not medical advice and they do not establish any physician-patient relationship.


Topics: Life insurance medical underwriting, Dr. Jack Cotlar, case management, rating, communicate, Underwriting, substandard case, diabetes, underwriting assessment

MIB and coding

Posted by Jack Cotlar on Mon, Feb 27, 2012 @ 04:55 AM

MIB is as important to the insurance underwriting process as it is misunderstood. What MIB is, what it does and what it does not do was the?topic of my most recent blog, “What you need to know about MIB and how it functions It generated several emails from life insurance agents.

Their main concern was that if a test is "coded" because of being abnormal, an adverse underwriting decision will necessarily?happen. This is not the case. Often the abnormal test result does not have underwriting significance and because, by MIB rules an adverse underwriting decision is not to be based solely?upon an MIB code. In addition, a subsequent test that was coded normal might negate the significance of the earlier abnormally coded test. Case in point ... as the Medical Director of?an insurance company I was asked to interpret an EKG done in February 2012, which was normal. We are aware that there is an abnormal MIB EKG?code from January 2011. The underwriter will "code" the current EKG as being normal so that another underwriter seeing the case in the future?will have a more complete and accurate picture of the EKG information.

Topics: Strategic Medical Consulting, MIB, Life insurance medical underwriting, Insurance medical underwriting, Dr. Jack Cotlar, Underwriting