A Matter of Semantics

[Bob_The_Insurance_Guy]

I am meeting with someone later this week, who has Tetralogy of Fallot. The definition of this affliction is as follows:

Tetralogy of Fallot (TOF) is one of the most common congenital heart disorders (CHDs). This condition is classified as a cyanotic heart disorder, because tetralogy of Fallot results in an inadequate flow of blood to the lungs for oxygenation (right-to-left shunt) (see the following image). Patients with tetralogy of Fallot initially present with cyanosis shortly after birth, thereby attracting early medical attention.

And here is the knockout question for the Medicare Advantage Plus Plan:

In the past 12 months have you been treated for chronic obstructive lung disease, insulin dependent diabetes, dementias, Alzheimer's disease, congestive heart failure, or chronic liver or kidney disease?

Is congenital heart disease and congestive heart failure one and the same, or can I skate around on the verbage. It is 8 in the morning, so I've had no time to call the underwriting department at GTL.

Thought I'd run it through here first.

 

[briko3]

I am meeting with someone later this week, who has Tetralogy of Fallot. The definition of this affliction is as follows:

Tetralogy of Fallot (TOF) is one of the most common congenital heart disorders (CHDs). This condition is classified as a cyanotic heart disorder, because tetralogy of Fallot results in an inadequate flow of blood to the lungs for oxygenation (right-to-left shunt) (see the following image). Patients with tetralogy of Fallot initially present with cyanosis shortly after birth, thereby attracting early medical attention.

And here is the knockout question for the Medicare Advantage Plus Plan:

In the past 12 months have you been treated for chronic obstructive lung disease, insulin dependent diabetes, dementias, Alzheimer's disease, congestive heart failure, or chronic liver or kidney disease?

Is congenital heart disease and congestive heart failure one and the same, or can I skate around on the verbage. It is 8 in the morning, so I've had no time to call the underwriting department at GTL.

Thought I'd run it through here first.

It's not the same thing.
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That being said, it's better to ask on the front end then to get a denied claim on the backend.

 

[tlmarketing]

not the same thing, as you can have a congenital heart disease such as a valve disorder that does not necessarily lead to heart failure...Mayo Clinic has a lot of good examples of this scenario.

 

[VolAgent]

Congenital means that it exists from birth.

Congestive means that it is overfilled or flooded.

Completely different meanings.

 

[jdeasy]

I am meeting with someone later this week, who has Tetralogy of Fallot. The definition of this affliction is as follows:

Tetralogy of Fallot (TOF) is one of the most common congenital heart disorders (CHDs). This condition is classified as a cyanotic heart disorder, because tetralogy of Fallot results in an inadequate flow of blood to the lungs for oxygenation (right-to-left shunt) (see the following image). Patients with tetralogy of Fallot initially present with cyanosis shortly after birth, thereby attracting early medical attention.

And here is the knockout question for the Medicare Advantage Plus Plan:

In the past 12 months have you been treated for chronic obstructive lung disease, insulin dependent diabetes, dementias, Alzheimer's disease, congestive heart failure, or chronic liver or kidney disease?

Is congenital heart disease and congestive heart failure one and the same, or can I skate around on the verbage. It is 8 in the morning, so I've had no time to call the underwriting department at GTL.

Thought I'd run it through here first.

I haven't done MA plans in 3 years now. When did they start having medical questions other than the ESRD question?

 

[arnguy]

I haven't done MA plans in 3 years now. When did they start having medical questions other than the ESRD question?

I think Bob's Medicare Advantage Plus Plan is guilty of being anti-semantic!

 

[Bob_The_Insurance_Guy]

I think Bob's Medicare Advantage Plus Plan is guilty of being anti-semantic!

טאַקע, אַז ס צו מאָדנע.