Underwriting Tip:
While some carriers don’t allow coverage for heart surgery, heart attacks, stents, or CHF, OmniFlex does offer options-even for cardiac conditions.
The only hard stop: insulin-dependent diabetes with heart failure.
Stents, Bypass, and the “Heart Failure” Trap: What Underwriting Really Sees
Recently I was asked about the connection between stents and heart failure in underwriting for short-term care products.
Clients hear “heart procedure” and panic. Agents hear “stent” and assume decline.
But here’s the truth: a stent or bypass isn’t heart failure-and it doesn’t always mean trouble in underwriting.
In fact, if you ask the right questions, you might be looking at a clean approval with full benefits.
What Actually Is Heart Failure?
Let’s clear this up.
Congestive Heart Failure (CHF) isn’t a procedure, it’s a diagnosis.
It means the heart’s pumping ability is weakened. It’s a functional decline, not just a past event.
Underwriters look for:
- Ongoing fluid retention (legs, abdomen, lungs)
- Shortness of breath with everyday activities (stairs, walking to the mailbox)
- Oxygen use (full-time or during exertion)
- Hospitalizations for heart issues, especially related to fluid buildup
Medications Can Tell a Story
Meds often speak louder than diagnoses.
Here’s what to watch for:
- Loop diuretics like Lasix (furosemide) or Torsemide help remove excess fluid.
If your client is on one, ask why. It might point to CHF-or could be for something less serious like high blood pressure or kidney issues. - Multiple heart meds used together often suggest ongoing heart failure management. Red flag combos include:
- Beta blockers (Metoprolol, Carvedilol)
- ACE inhibitors/ARBs (Lisinopril, Losartan)
- Diuretics (Lasix, Torsemide)
- Spironolactone
- Entresto – usually confirms CHF
- Digoxin – older, but still used in CHF care
If your client is on several of these, dig in.
If they’re taking them for something else-like liver issues or controlled hypertension-get that diagnosis and list it clearly on the app.
Pro tip: A single diuretic for blood pressure isn’t a big deal. A full cocktail of cardiac meds might be.
Stents and Bypass – What They Really Mean
These are interventions, not diagnoses.
A stent opens a blocked artery.
A bypass reroutes blood around a blockage.
They’re done:
- To treat or prevent a heart attack
- After an abnormal stress test or angina symptoms
- Sometimes electively, before any real damage is done
Here’s the kicker:
Many people with stents or bypasses go on to live healthy, symptom-free lives-especially if it’s been years.
Underwriting wants to know:
- When was the procedure? (Timing matters)
- Why was it done? (Heart attack or precautionary?)
- How are they now? Stable or symptomatic?
- Any follow-up care? (Cardiologist visits, stress tests, etc.)
What to Ask Clients
You don’t need to be a cardiologist-just ask the right questions:
- “When did you have the stent or bypass?”
- “What led up to it-chest pain, heart attack, abnormal test?”
- “How have you felt since-any shortness of breath, swelling, or fatigue?”
- “Do you follow with a cardiologist?”
- “What meds are you on? Blood thinner, statin, beta blocker?”
These answers help you set the stage-and the right expectations.
When It Is a Red Flag
Sometimes stents or bypasses do signal higher risk.
Red flags to watch for:
- Procedures done in the last 12–24 months (not enough stability)
- Ongoing symptoms like breathlessness, swelling, or limited activity
- Diagnosed CHF or low ejection fraction
- Diabetics with heart complications
- Oxygen use or recent ER visits for fluid overload
These aren’t always auto-declines-but they may lead to delays, benefit reductions, or declines, depending on the carrier.
Conclusion
Not every heart story ends in decline.
Ask better questions. Clarify symptoms and timelines.
You might find a rock-solid case hiding behind a scary-sounding surgery.
Renee Stutes