A Convenience Conundrum: Underwriting in a Telehealth-Capable World
Living in an era of convenience has undoubtedly impacted nearly every aspect of our lives. Need groceries? Place a digital order in the morning for a delivery before dinnertime. Your kid forgot a posterboard and markers for the project due tomorrow? Order it on Amazon for same-day delivery. Want to read that new release from your favorite author? Download it now on your Kindle app.
The healthcare industry is making similar strides to improve the accessibility of their offerings in both products (i.e., Semaglutide) and services (i.e., virtual appointments) alike. I enjoy convenience and instant gratification as much as the next person, but I have a front row seat for how these “conveniences” can negatively impact the life insurance underwriting process. This week’s ONE Idea will focus on three specific areas of the telehealth industry where our underwriting team has had to intervene to ensure a favorable assessment:
- Mental Health;
- Weight Loss Management/ Semaglutide; and
- Testosterone Therapy.
The goal of this article is to provide our AgencyONE 100 advisors and their clients with the necessary guidance to avoid roadblocks on cases with comparable histories.
Telehealth
First and foremost, what is Telehealth? Mayo Clinic’s basic definition of telehealth is, “the use of digital information and communication technologies to access health care services remotely and manage your health care. Although Telehealth existed before the pandemic, in-office visits were still the norm. As a result of Covid 19, Telehealth usage has soared and is now a permanent and valuable part of medical care, offering significant benefits to both healthcare providers and patients. In my opinion, it should be viewed as a good option for supplemental care, but it does not negate the need for regular screenings in the traditional sense. This becomes especially evident in the underwriting process.
Mental Health
It is a well-known fact that the accessibility of mental health resources remains a major pain point for the U.S healthcare system and those looking for care. A substantial number of mental healthcare providers changed to virtual care during the pandemic and most of them have remained that way. Having access to medical health professionals in a virtual setting assists in providing accessible, consistent, and improved care.
Generally speaking, most of the cases our underwriting team encounters where psychiatric medications are prescribed through virtual means (i.e., via hers or hims health) tend to be mild in severity – for example, mild anxiety, mild depression, situational depression, job stress, etc. When it comes to assessing these risks in underwriting, the key is to establish a history of care and reconcile that history with the available data. The key factors in the assessment process include:
- Receiving full disclosure of the diagnosed conditions, the treatment(s) used, and related timeline.
- Reconciling the health history with prescription and medical claims data.
- Receiving documented stability on the current treatment, i.e., maintenance on the same dosage for an extended period without issue (6-months+). Similarly, it must be determined if additional medications are/were needed to supplement treatment of the condition.
In these Telehealth scenarios, true/ comprehensive medical records can be scarce or potentially unavailable. Including a detailed account of the client’s medical history with the formal application can help ensure a smoother underwriting process.
SemaGlutide/ GLP-1
Semaglutide is a weekly injection used to treat type 2 diabetes and/or aid in weight loss and long-term weight management. It is more commonly referred to as Ozempic, which is one of the several brands of Semaglutide. I would be genuinely shocked if a full week went by without encountering a case that involved Semaglutide. In underwriting, it’s becoming increasingly common to see medications prescribed through Telehealth services – almost a daily occurrence.
Similar to mental health, the most important part of the assessment is establishing the diagnosis and associated timeline. Is the client using Semaglutide for diabetes or just weight loss? This is generally the first question underwriters have when reviewing these files and providing this information at the inception of underwriting is extremely helpful. Underwriters will use the data available (historical lab work, claims data, prescription check, etc.) along with the client’s declarations to answer that question and finalize their assessment.
Testosterone Therapy
Testosterone therapy just might be the trickiest of the three topics. Does the patient have a true diagnosis of low testosterone? Is it based on just one testosterone level or several that show consistently low results drawn over a span of time? For any client receiving testosterone therapy, there needs to be significant oversight of care accompanied by regular lab work. Along with checking testosterone levels, the client’s CBC (complete blood count) and PSA (prostate specific antigen) should be regularly monitored to confirm there are no abnormalities secondary to the use of testosterone. If there are abnormalities, the testosterone treatment may be adjusted or discontinued altogether.
Without the necessary oversight by a physician, this is a scenario that carrier underwriters are unable to accurately assess and therefore are likely to postpone coverage until the appropriate supplemental investigations are completed (CBC, PSA, and regular Testosterone panels).
Telehealth has undeniably improved access to care, but its convenience can create challenges in the life insurance underwriting process. By proactively addressing gaps/ issues in documentation and providing clear medical histories, our AgencyONE 100 advisors can help ensure smoother, more favorable outcomes for their clients.
Contact AgencyONE’s Underwriting Department at 301.803.7500 for more information or to discuss a case.
