Is Gastric Bypass an auto decline?

Sep 7, 2007

  1. Golddoor
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    I have a lead that had Gastric Bypass last year. She is 5'3 136#. Non Smoker. Lost 83# in the last year. Would she be an auto decline with most companies?
     
  2. CHUMPS FROM OXFORD
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    Usually...you need five years from the surgery.

    5-3 136. She's doing well. I'm surprised she was even a candidate at 5-3 219.
     
  3. Alston
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    In my experience in Connecticut, yes.

    However, the gastric bypass is a relatively new procedure. Maybe when the insurance companies have more data on those who have had the procedure, the underwriting will loosen up.
     
    Alston, Sep 7, 2007
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  4. somarco
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    somarco GA Medicare Expert

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    Without looking it up, I can't think of a carrier that will take someone who has had GB surgery. Too many things can go wrong after the fact.

    For one, it messes up absorption. That means meds (most of which are designed to dissolve in the stomach) usually don't work. They don't stay in the stomach long enough to break down and get into the blood stream. That pretty much rules out all but injectables and enteric coated pills.

    You can counter-act a bit by precribing & taking higher doses in hopes that enough of the med will dissolve and dissipate to the blood stream before it flushes through.
     
    somarco, Sep 7, 2007
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  5. Golddoor
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    I just recieved back an Underwriting Request Form from Aetna and they said they would write it with a "B" Rating.
     
    Last edited: Sep 7, 2007
  6. BKrocko
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    Good job. Make sure to let us know the final underwriting decision. The last app I submitted w/Aetna turned into a decline even though the pre screen wrote back that it would be a B rating.

    My pre screen included information about the prospect having herpes and taking Valtrex. I was informed that they have now revised the underwriting guidelines to make it a decline - said that the information given to me about the B rating was correct at that time but the underwriting revision took effect within the week that the app was submitted.
     
    BKrocko, Sep 7, 2007
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  7. somarco
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    somarco GA Medicare Expert

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    They do have new guidelines that went into effect maybe 2 months ago. However, unless there was a major time lapse between the pre-screen and submitting the app, they should have honored the original "offer".

    That is poor judgement on their part.
     
    somarco, Sep 7, 2007
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  8. Golddoor
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    Im kind of suspicious about this one to. I have also had that happen a few times. Mostly with Uniscare though!
     
  9. Macdaddy
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    I recently wrote a female that had a lap band surgery which is much less of a risk than GBS. The underwriter has requested an APS and said they don't like these kind of surgeries because historically these folks generally DO put the weight back on.
     
  10. TXINSURANCE
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    Losing 83 pounds in one year is pretty risky business - she needs more time with good health maybe 2-5 years, I would say go group, risk pool / HIPAA depending on the state.
     
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