Med Supp (Lumico) question

Aug 9, 2019

  1. Limozine
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    Limozine Expert

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    I am considering Lumico for a Med Supp client here in SC. One of the health questions is: " Have you been advised by a physician to have surgery (including cataract or joint replacement surgery), medical tests, injections in a physician’s office, infusions, or therapy that has not been performed?"

    Her answer was that she was advised NOT to have an "elective" (her word) hernia operation about three months ago because it was "too risky" (she's 81 and apparently the doctor felt that the risks of such an operation outweigh the reward.)

    So she can truthfully answer that with "no," IMO. But might it come back to haunt her? Underwriting is closed for the weekend, so I thought I'd get some opinions here.
     
  2. somarco
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    somarco GA Medicare Expert

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    If she is honest during the phone interview it is not a problem . . . because they will most likely reject her application,

    This is a problem waiting to happen.

    Move on to the next one .. .
     
    somarco, Aug 9, 2019
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  3. crs6633
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    crs6633 Expert

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    This will be an underwriting decline. Surgery or no.
     
    crs6633, Aug 9, 2019
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  4. goillini52
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    goillini52 KeepAmericaGreat...Eat Bacon & BUILD THAT WALL!!!

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    I wouldn't write it before checking with UW.
     
  5. Todd King
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    Todd King IMO/FMO Owner

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    Have you been advised by a physician to have surgery (including cataract or joint replacement surgery), medical tests, injections in a physician’s office, infusions, or therapy that has not been performed?

    I personally think the answer is a no. She has been advised NOT to have the surgery, so therefore the straight up answer to this question is 'no'.
     
  6. Limozine
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    I agree with that answer, and when I called the underwriter today she seemed confused that I was even asking her the question. The doctor advised the client against surgery, so the answer is 'no.'

    So what if she applies and IS approved? Is there any risk to her down the road?
     
    Limozine, Aug 13, 2019
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  7. Devin01
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    Devin01 Guru

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    I would write this case she was told the risks outweigh the benefits. I agree with Todd that this is a viable case.
     
    Devin01, Aug 13, 2019
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  8. somarco
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    somarco GA Medicare Expert

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    Does Lumico conduct post issue underwriting audits? What is their lookback period? Any attestations on the app regarding statements about health history?

    You are taking her word that the doctor did in fact refer to the hernia repair as "elective". What kind of hernia? What if her condition changes and it goes from elective to "must do"? Will Lumico still cover it or deny the claim because it was not disclosed on the app or during any underwriting phone call?
     
    somarco, Aug 13, 2019
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  9. Limozine
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    Ok, it turns out she also has Lymphedema, and that's one of the KO questions for Lumico. Anyone know of a carrier who takes Lymphedema cases?
     
    Limozine, Aug 13, 2019
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  10. goillini52
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    goillini52 KeepAmericaGreat...Eat Bacon & BUILD THAT WALL!!!

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    So, we've gone from an unoperated hernia to cancer. :wacko:

    Details?
     
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