Depressed--Trying to get Individual Policy

[Wheel]

I hope the board doesn't mind if I vent a little. I ER'ed in August, and did not figure I'd have too big a problem getting an individual policy. However, I've now been rejected by 2 companies because of my height/weight. I am heavy (not that bad, though!) and am trying to lose some weight (not easy during the holidays). I walk 3-5 miles daily, work out twice a week, and actually run while refereeing soccer games. Unfortunately I've got pretty short legs and a long torso, hence I weigh more than the "norm" for my height.

My broker tells me I should accept the insurance company's offer to insure DW and 2 DD's, stay on COBRA until exhausted and then go into the states high risk pool.

I do have 1 question that hopefully someone may be able to help with--am I forever tainted with the companies I've applied to or if/when I lose some more weight can I reapply and hopefully be accepted then?

Thanks for letting me vent.

--Wheel

 

[mykidslovedogs]

Different carriers have different guidelines for height and weight. Many carriers are now going to the body mass index which gives a little more flexibility to carriers in offering coverage to those that are overweight. If Aetna is doing business in your state, they seem to have looser guidelines on body mass index. While you would likely be rated, you might have a chance at coverage with another carrier that uses body mass index tables instead of height/weight tables.

By the way, if you don't mind disclosing your height/weight, I can do some research for you and find out which carriers you might have better luck with. Or....you can try doing a search on www.ehealthinsurance.com. I think they require you to fill in your height/weight and their search engine might filter out possible carriers based on your input. Lastly, you could check with an agent in your state and ask them to do a "prescreen" for you before trying to apply with any other carriers.

 

[youbet]

I do have 1 question that hopefully someone may be able to help with--am I forever tainted with the companies I've applied to or if/when I lose some more weight can I reapply and hopefully be accepted then?

I don't know the answer but I'd be very interested in hearing what your broker says about that. Please let us know.

 

[mykidslovedogs]

I don't know the answer but I'd be very interested in hearing what your broker says about that. Please let us know.

You are not forever tainted. I've had a client that had gotten just one pound below the max and have re-applied with Blue Cross and have been accepted

 

[tryan]

wow ... is there a table/link available with the weigh guides?

 

[mykidslovedogs]

I only wish there was. Your best bet is to talk to a local agent who has access to each carrier's underwriting guidelines. I do business with all of the major carriers, and while I only have access to the Colorado Agent Guides, I suspect height/weight tables will be similar from one state to the next. If anyone wants me to look anything up for them, I'll be happy to.

 

[TromboneAl]

It might be a worthwhile investment to get some professional help in losing the weight.

 

[lazygood4nothinbum]

i'm 5-10, 214 lbs & about 20% body fat. i look fabulous at 200 lbs & 15% bf and if i really struggled i might be gorgeous at 190 lbs & 10% bf (well, all that and twenty years ago).

i'm on my way back to fabulous. the last year of dealing with mom took its toll. indeed, had alzheimer's lasted another two years i'm pretty sure i'd be 400 lbs and would have beat her to my grave.

good health wise i only need be between 11 & 23% bf according to what i've read, so i'm still within good limits. i was up to 222 lbs when i buried mom so i'm already doing much better.

my normal routine is weight training every other day, biking about 15-20 miles a few times a week and swimming laps 1/2 to 1 mile also a few times a week. i'm on my way back to that as well.

but because the insurance company only goes by that bmi height and weight nonsense, they consider me obese and are charging me an extra 20plus $s per month because i am not 189 pounds at 5-10.

i was 175 lbs in high school with no body fat. i hadn't even developed a chest yet. but the insurance company will not reduce my premiums even if i somehow manage now to get back to my high school weight.

i don't even know how i'd do that. i would have to reduce more muscle mass and bone density than body fat.

it really is such a rip-off. at 49 i've been a vegetarian for about 10 years, haven't smoked in about 15 and haven't had a drink in about 8 years (well, i've been drinking socially in last few months but i reallly don't like it much). i have a coffee a few times a year, no soda and i eat mostly organic products. at my last doctor visit a few weeks ago, the guy took my blood pressure and looked at me with pleasant surprise on his face and said, "it's excellent."

try telling that to the insurance companies. they only see numbers. if i had completely stopped taking such good care of myself. if i'd let my body deteriorate so that i was 189 lbs of mostly fat instead of bone & muscle, i'd have gotten the discount. as it is now, they will not give me a discount even if i did that because i've already been accepted at their inflated rate.

so definitely take this year and get yourself into the best shape you can (starting off slowly so you don't shock your system) before you reapply. more than helping you get insurance, it will make you feel wonderful and likely will give you more years to continue paying their unfair rates.

 

[mykidslovedogs]

it really is such a rip-off. at 49 i've been a vegetarian for about 10 years, haven't smoked in about 15 and haven't had a drink in about 8 years (well, i've been drinking socially in last few months but i reallly don't like it much). i have a coffee a few times a year, no soda and i eat mostly organic products. at my last doctor visit a few weeks ago, the guy took my blood pressure and looked at me with pleasant surprise on his face and said, "it's excellent."

try telling that to the insurance companies. they only see numbers. if i had completely stopped taking such good care of myself. if i'd let my body deteriorate so that i was 189 lbs of mostly fat instead of bone & muscle, i'd have gotten the discount. as it is now, they will not give me a discount even if i did that because i've already been accepted at their inflated rate.

I just looked up your BMI in the Aetna Underwriting Guidelines. Your score is a 30-31. According to Aetna's underwriting guidelines you would qualify for a standard rate. That's their best rates! If Aetna is doing business in your state, you might want to consider applying. Especially if you have no other health conditions or risk factors. Keep in mind that there are other conditions that can cause a rate up such as high blood pressure or elevated cholesterol or triglycerides.

Have you tried appealing your rate-up yet? I'll bet if you send in an appeal with your current carrier, they might consider removing the uprating. Especially if your BMI falls within their standard rating guidelines.

 

[Andre1969]

I just plugged in my BMI to an online calculator I found and according to it I'm overweight! Just barely, but still in the overweight category! I'm 6'3", 200 pounds. Which comes out to a BMI of 25 according to the calculator. And they considered 24.9 to be the cutoff for "normal".

And hell, even at 200 pounds, I think I'm skinny!

 

[haha]

It's easy to lose 10 pounds in a few days if you need to; ask any high school wrestler. Restrict salt, drink plenty of water, eat little. If you need it, grab a diuretic to get you under your cutoff.

Ha

 

[lazygood4nothinbum]

Your score is a 30-31. According to Aetna's underwriting guidelines you would qualify for a standard rate. That's their best rates!

ya, well, i was being dramatic for affect. i did get the standard rate with this company but i wanted the premium rate i was quoted before they baited & switched me. i'm not used to buying retail and i don't like it. as to other conditions, i've not really that but another issue for which i'll open a different post on so as not to hyjack this one.

 

[mykidslovedogs]

ya, well, i was being dramatic for affect. i did get the standard rate with this company but i wanted the premium rate i was quoted before they baited & switched me. i'm not used to buying retail and i don't like it. as to other conditions, i've not really that but another issue for which i'll open a different post on so as not to hyjack this one.

This is just an FYI for all of the readers out there who are following this topic:
On internet insurance quoting engines, all carriers are going to quote their preferred rates (rates that are available for the healthiest individuals). Believe it or not, the majority of people will qualify for the preferred rates. It would be too hard for insurance carriers to quote every single scenario, so they quote the best possible rate you can get. At the bottom of the quote, written right in the disclaimer section, you will see that they all say that rates are not guaranteed and final proposals will depend upon the medical underwriting of the case.

 

[SecondCor521]

This is just an FYI for all of the readers out there who are following this topic:
On internet insurance quoting engines, all carriers are going to quote their preferred rates (rates that are available for the healthiest individuals). Believe it or not, the majority of people will qualify for the preferred rates. It would be too hard for insurance carriers to quote every single scenario, so they quote the best possible rate you can get. At the bottom of the quote, written right in the disclaimer section, you will see that they all say that rates are not guaranteed and final proposals will depend upon the medical underwriting of the case.

I believe this is also SOP if you call a local insurance agency as well.

2Cor521

 

[mykidslovedogs]

try telling that to the insurance companies. they only see numbers. if i had completely stopped taking such good care of myself. if i'd let my body deteriorate so that i was 189 lbs of mostly fat instead of bone & muscle, i'd have gotten the discount. as it is now, they will not give me a discount even if i did that because i've already been accepted at their inflated rate.

I really can sympathize with you on this point, but insurance companies have to be able to assess risk in some kind of efficient way. They've found that the body mass index is a good risk predictor, so it makes sense that they have cutoffs for different rating scales. I don't see how they could do it any other way without losing efficiency in moving things through underwriting quickly. If they had to order medical records for everyone, they would have trouble moving the apps through underwriting in a timely manner and everyone would be ticked about the long wait for the final offer.

 

[mykidslovedogs]

I believe this is also SOP if you call a local insurance agency as well.

2Cor521

Actually, when clients ask me for quotes, I usually ask about health history first so I can do a prescreen and that way, I'm better able to tell them what the likely underwriting outcome will be.

 

[Martha]

Believe it or not, the majority of people will qualify for the preferred rates.

Actually, when clients ask me for quotes, I usually ask about health history first so I can do a prescreen and that way, I'm better able to tell them what the likely underwriting outcome will be.

I have also read that most people who apply do qualify for the preferred rates, but I also have read that people who are clearly uninsurable don't apply. So it may be only the iffy cases get turned down and the statistic is distorted by self selection. For example, I talked to an insurance agent I know in Minnesota and he said it is pointless for either my husband or I to apply and we might as well go straight to the risk pool.

 

[mykidslovedogs]

I have also read that most people who apply do qualify for the preferred rates, but I also have read that people who are clearly uninsurable don't apply. So it may be only the iffy cases get turned down and the statistic is distorted by self selection. For example, I talked to an insurance agent I know in Minnesota and he said it is pointless for either my husband or I to apply and we might as well go straight to the risk pool.

I'm sure you're probably right on that. I should have worded it that of all the people that do apply, most will qualify for the preferred rates. It's probably smart to avoid applying if your prescreen indicated that a decline would be likely. Sometimes it depends on the carrier. For example, I had a client with a number of different minor conditions, but because of the COMBINATION of conditions, most of the carriers I prescreened with said it would likely be a decline. Then, we tried one more carrier (Golden Rule), and I couldn't believe that she got the standard rates with only one exclusion rider for Osteopenia. She has a few years left untill she's eligible for Medicare, so she was willing to take the risk that she wouldn't incur any claims related to Osteopenia during that time frame.

 

[unclemick]

Question

Does being close to Medicare age help? I got (age 63) bc/bs in MO - 5k deductible even though I smoked and had high blood pressure (140/90). 200/mo.

Now I just changed to 10k deductible for about 150/mo - I'll be 64 this year.

heh heh heh heh - remember I'm the block head who went 12 yrs with no insurance - the quotes when I lived in New Orleans ran about 500/mo and higher.

 

[mykidslovedogs]

Question

Does being close to Medicare age help? I got (age 63) bc/bs in MO - 5k deductible even though I smoked and had high blood pressure (140/90). 200/mo.

Now I just changed to 10k deductible for about 150/mo - I'll be 64 this year.

I don't think being close to medicare age helps much, but purchasing a high deductible vs. a low deductible definately does help. Humana One recently loosened underwriting guidelines (not guaranteed issue, but better chance of getting standard rates instead of an exlcusion or decline) on many conditions for those people who apply for high deductible plans. Among the conditions are:
Arthritis
Asthma
ADHD
Diverticulitis
GERD
Hyperthyroidism
Lipoma
Migraines
TB
Uterine Artery Embolization
Spinal Manipulations (beleive it or not, many insurance companies don't like people who get spinal manipulations)

 

[REWahoo]

Does being close to Medicare age help? I got (age 63) bc/bs in MO - 5k deductible even though I smoked and had high blood pressure (140/90). 200/mo.

C'mon, Unclemick. It's got nothing to do with your age, it's all about who you know. Since you're in tight with that Norwegian widow-woman, you get a deal on the rates.

 

[Martha]

I don't think being close to medicare age helps much, but purchasing a high deductible vs. a low deductible definately does help.

Interesting. I suppose a number of those non-lifethreatening conditions only nickle and dime you so you don't have a large risk of exceeding the big deductible.

 

[Rich_by_the_Bay]

Interesting. I suppose a number of those non-lifethreatening conditions only nickle and dime you so you don't have a large risk of exceeding the big deductible.

I've been told that insurance companies analyze the length of time a given purchasd policy will be held on to, based on age, underwriting, etc. If they feel your risks are unlikely to manifest as disease within that interval, you receive a better rating. If they are more likely to manifest while the policy is in force, adios. I do not know if this is true, but I do know that it is not implausible.

 

[mykidslovedogs]

Interesting. I suppose a number of those non-lifethreatening conditions only nickle and dime you so you don't have a large risk of exceeding the big deductible.

Hi Martha,

Is there a place to post .pdf files on this site? I would like to send you a page from one of the carrier's underwriting guidelines booklets to help you all understand the mystery behind underwriting. Basically, it's all based on rules. Depending on how long the condition has been active or what the current status of the condition is, you can be rated or excluded or declined for that condition. Each carrier has their own rules.

You hit the nail on the head with the underwriting guidelines on the high deductible plans. Since there is less risk of hitting the deductible, certain conditions are now written as standard.

 

[Zoocat]

FYI, I was accepted for a policy by World Insurance. They have more lenient underwriting than most others. Good luck!