Recomended Surgery for Cataracts?

thomasm

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Nebraska
Had a lady call me back to mention she forgot about her being recommended for cataract surgery when I took her app this morning.

I already submitted the app. She'll probably bring it up when they call.

Will this decline the app? It was PALIC med supp app.
 
Had a lady call me back to mention she forgot about her being recommended for cataract surgery when I took her app this morning.

I already submitted the app. She'll probably bring it up when they call.

Will this decline the app? It was PALIC med supp app.


Yes, they ask if surgery's been recommended in the past 2 years that hasn't been performed yet. I'd call the company and withdraw it, then write her back up when the surgery is done and she's released.
 
Yes, they ask if surgery's been recommended in the past 2 years that hasn't been performed yet. I'd call the company and withdraw it, then write her back up when the surgery is done and she's released.

Now correct me if im wrong (which I know you will lol), if the doctor has advised her that she will need it someday, but not necessarily in the next 12 months, then she could answer no to the question? (Im thinking of MOFO where it asks if the surgery my be required in the next 12 months, but it doesn't reference the past 2 years part)
 
I had a case a couple weeks ago where a woman went to an eye Dr that just happens to do cataract surgies (Tues & Thurs every 15 min from 9 -5 on his own equipement). Of course, he recommended surgery. Said she would need it within the next 2 years. So she went to another eye Dr. who doesn't do surgeries and that Dr sayed she does not need surgery. Cataract issues are minor.

Now what? :-) How is she to answer that question? She isn't going to get surgery, her vision is fine and cataracts are not an issue. It's obviously a case of a Dr. trying to generate income. Those guys are worse than insurance agents! ;-)
 
Now correct me if im wrong (which I know you will lol), if the doctor has advised her that she will need it someday, but not necessarily in the next 12 months, then she could answer no to the question? (Im thinking of MOFO where it asks if the surgery my be required in the next 12 months, but it doesn't reference the past 2 years part)

I'm assuming the Philadelphia American app is the same as New Era's...it asks if surgery has been advised...it has.

Most companies ask about cataract surgery being recommended in the past year. PA's doesn't...just asks about surgery. Cataract surgery is surgery.

Aetna asks if cataract surgery has been recommended in the past 12 months. I had a lady that she remembered during the PHI that cataract surgery had been recommended in the past 12 months, but she didn't want the surgery. Aetna told me that once it's it's been over 12 months since it was recommended and it hasn't been done yet, she qualifies.

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I had a case a couple weeks ago where a woman went to an eye Dr that just happens to do cataract surgies (Tues & Thurs every 15 min from 9 -5 on his own equipement). Of course, he recommended surgery. Said she would need it within the next 2 years. So she went to another eye Dr. who doesn't do surgeries and that Dr sayed she does not need surgery. Cataract issues are minor.

Now what? :-) How is she to answer that question? She isn't going to get surgery, her vision is fine and cataracts are not an issue. It's obviously a case of a Dr. trying to generate income. Those guys are worse than insurance agents! ;-)

I'm sure if her Dr. gave her a letter saying she didn't need cataract surgery, the company would accept that.

I think you meant to say worse than Bankers Life agents.:laugh:
 
Had this same issue.

Client qualifies for and wants SNL preferred, but of course SNL won't accept her until her cataracts issues are completely resolved. Honestly, in this day and age, who the h*ll dies of complications from cataracts?? I suggested to her Settlers Gold, since they don't care about pending recommended surgeries, but she likes SNL's easy payment terms. So she's passing on coverage now. And that doubly sucks, because her existing policy is a ripoff Lincoln Heritage policy in which the agent falsely wrote her up as non tobacco. Ridiculously replaceable.

Sigh.:1mad:
 
Now correct me if im wrong (which I know you will lol), if the doctor has advised her that she will need it someday, but not necessarily in the next 12 months, then she could answer no to the question? (Im thinking of MOFO where it asks if the surgery my be required in the next 12 months, but it doesn't reference the past 2 years part)

I think you are correct on the true intent of this question, However dif companies and dif underwriters are going to ask the question in dif ways, The bottom line when she says yes it is a decline.

I do believe there is a dif when it is suggested that the surgery to be done within a year, or if a doc says yea you probably should get that done someday.

However if the client says yes it is over

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In fact the only time I had this come up the question was read in app have been suggested to get it done withing the next year.

I told her hey this is the way the question reads, However if you tell the underwriter beyond what it reads they can use that information.

That person had no issues on the underwriting call

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However I did say to her that I would not say no to that question IF she thought at all she would get the surgery in the next 12 months
 
Had a lady call me back to mention she forgot about her being recommended for cataract surgery when I took her app this morning.

I already submitted the app. She'll probably bring it up when they call.

Will this decline the app? It was PALIC med supp app.







The good news is you can tell her is that OP cataract surgery cost share shouldn't amount be much more than a monthly med supp premium
 
Medicare covers conventional IOL's. Patient will have to come up with the difference between conventional and any of the premium IOL's.
 
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