Archive for April, 2008
I get so tired of doctors (what’s new?) who make a diagnosis and just give people prescriptions and basically just tell them to go away and take their medicine.
My office manager’s mother was recently diagnosed as being type 2 diabetic. She was put on Metformin and told to come back in three months for a checkup. Being a good working knowledge of diabetes from having work on literally hundreds of cases in her career in life insurance, she began to ask her mother questions. What was her A1c? Mom didn’t know. What did the doctor suggest to do other than take the medication? Nothing. What was the diagnosis based on? A one time glucose reading of 113!!! Were there any other labs out of normal? Didn’t know. Did the doctor discuss what’s normal and what it would take to get back to normal on a long term basis? No!!!
This guy is a quack of the worst kind. No retest. No A1c. No recommendation to try diet and exercise first. No education as to why he recommended what he did and what type 2 diabetes means in the whole scheme of things.
Bottom line. I think every exam room should have a computer link to Google so that when a doctor makes a diagnosis, they can immediately pull up information for a client and discuss and print it out so that the client understands their diagnosis or misdiagnoses, what their options are and what their prognosis should be given the different options. Doctors that just write prescriptions and turn and walk out should be given a CDL and told to go drive trucks for a living.
April 21st, 2008
I watched a program on 60 minutes last night that reviewed the impact of gastric bypass surgery not just on obesity, but on all of the other risk factors that a person takes on when they are overweight. The results weren’t surprising, but rather affirming based on my experience of working with people who have battle obesity and won.
The stories of the eight people they interviewed were all dramatic in their own right. One lost 160 pounds, another 96 pounds, another 130 pounds and one lost 260 pounds. Incredible weight loss. All 8 of them had type 2 diabetes prior to the gastric bypass. All 8 of them are now off of medication and no longer have diabetes. Some of them had sleep apnea and now none of them do.
One of the 8 was a doctor who had always recommended gastric bypass as a measure of last resort. He now says that he believes the benefits far outweigh the risks in the morbidly obese and believes that more people should consider the surgery rather than face a life of increased risk of diabetes, heart disease and cancer.
Life insurance companies are often characterized as beating up on the overweight by offering them higher rates than those who, according to their build charts, are less of a risk. I know the feeling of being offered a higher rate than I think I deserve, but the reality is that when it comes to obesity there are so many potential collateral health issues, that companies aren’t over reacting. The best that someone who is overweight can hope for is to lock in as good a rate as they can before they have any other health issues. After getting coverage they should go about reducing the risk through weight loss whether by diet, exercise, gastric bypass or stomach banding and then reapply for a better rate. The truth is that the life insurance rate shouldn’t be the impetus to take the necessary steps. Prolonging your life should be reason enough.
Another statistic that came from the show, a rather amazing thing when you look at the long term success of diet and exercise, is that between 80 and 90% of those who have gastric bypass don’t regain the weight. And, with the procedure now done almost always laproscopically, it is much safer than in the past.
Bottom line. It should be for your own life and health, but if the reason is for better life insurance, the end result is the same. Lose the weight and your chances of serious disease go down, way down. Lose the weight and you live longer and have more fun, way more fun. Do it because it’s the right thing to do.
April 21st, 2008
I have no idea, but if someone has had a heart attack I know that one thing that won’t hurt their feelings is finding affordable life insurance rates. While I may not have a clue about broken hearts, I can shed some light on what life insurance underwriters look for when underwriting heart disease and heart attack cases.
The difference in underwriting is very subtle between heart disease (CAD)
and heart attacks. The real difference has to do with the problem being diagnosed before or after damage (ischemia) has occurred in the heart. If the damage is minimal the underwriting outcome will be virtually the same. As the damage level increases, rates become higher due to the weakened condition of the heart and subsequent possible shortened mortality.
Having said that, life insurance underwriters look at several key factors in weighing the risk.
1. Age of onset. This one isn’t too hard to imagine the impact. Just consider for a moment the difference in your reaction upon hearing that a 35 year old cousin had heart bypass surgery versus hearing that his father, a 60 year old, had the same occurrence. There isn’t anything normal about a young person having cardiac issues, so age of onset is important to underwriting. Generally, prior to 50 is going to increase the rates and prior to 40 will increase the rates dramatically.
2. How many vessels were involved? Whether there was a heart attack or not, we are generally talking about either bypass surgery or placement of a stent through angioplasty. The number of vessels is some indication of not only severity, but chance of recurrence. A one vessel issue will receive more aggressive underwriting than, say, four or five vessels.
3. Recurrence. It is not uncommon with chronic CAD for a person to have to go through more than one procedure. If these are less than three months apart it is generally looked at as one event and wouldn’t be considered chronic. Often these occurrences are years apart and that presents an obvious increased risk to the insurance company. As long as the heart, as shown through the results of a stress test, is still strong, insurance should be attainable although at higher rates.
4. Heart damage. Before accepting a risk on a cardiac case, insurance companies will want to see a stress test done post heart attack/bypass/angioplasty. Even 10 or more years out from the event, if a person hasn’t had a stress test within the previous two years, insurance companies will likely require one before considering approval. The primary assessment of heart damage from the stress test is the left ventricular ejection fraction (LVEF). This, simply put, is a measure of how efficiently your heart is pumping blood. A normal LVEF would generally be around 65%-70%. Insurance companies will generally not consider coverage if the measurement is below 50%.
5. Lifestyle. Underwriters pay close attention to whether or not the event got your attention. If you’ve had a cardiac event and, say, continue to smoke, if you are approved it will be at an extraordinarily high rate. Most companies will simply decline to accept the risk. They also look at fitness issues such as exercise and obesity.
Bottom line. Fair rates on life insurance are available for the majority of people who have been through a cardiac event. Thanks to modern medicine far less damage occurs on average than used to occur. What this means for insurance companies is that, rather than knocking someone out of the running for life insurance, it keeps them in the running and with the survival of the wake up call and lifestyle changes, mortality experience is good. You’re going to be around for a while.
April 16th, 2008
Can you stand just a little more evidence that healthy lifestyle choices do, in fact, help avoid serious health problems. Eat right and get plenty of sleep!! We’ve discussed several times how sleep, or lack of, can impact physical and mental health.
Now a large study shows that a diet that was originally concocted for people with high blood pressure has a fairly dramatic impact on the incidence of heart attacks and stroke.
This being political campaign season, I was struck with the difference between a medical study and a poll. With a political poll they might find out what a few thousand people are thinking over a few hour’s time. In this case the study involved 88,000 people followed over a 24 year period. This paragraph really didn’t have anything to do with anything other than I thought it was kind of interesting.
Anyway, a significant study for sure. The diet was no surprise emphasizing a lot of fruit and vegetables and protein sources that don’t all involve meat. The comparison was between those who followed the diet and those who ate “typical American diets”. Those on the high blood pressure diet were 24% less likely to have a heart attack and 18% less likely to have a stroke.
While life insurance can be attained in most cases following a heart attack or stroke, there is no doubt that, compared with the price of someone who hasn’t had one of those occurrences, there is a high likelihood of sticker shock.
Bottom line. Lifestyle choices happen every day and what we do with those very often determines how many days we get. We not only get to live longer, but we get to pay less for life insurance while we are here.
April 16th, 2008
I wouldn’t presume to beat a dead horse, but so seldom is there any significant shift in life insurance underwriting that it bears as much good press as it can stand. While life insurance companies have, for a long time, been fairly tolerant of mild situational depression, many companies are now taking a new look at what used to be a group of automatically declined mood disorders.
I have gone on and on about the results we are getting with well controlled bipolar disorder. Bipolar still leaves the majority of underwriters running, screaming into the dark. Then there is a group of companies that has taken pause to look at the whole issue from a new direction. What if this person really is a functional, stable member of society? What if they really have a track record of compliance with treatment and what if they haven’t been in and out of the hospital? What is the real risk?
Anxiety disorders and long term depression are getting the same fresh look from these companies. By the way, these companies are some surprising new upstarts that are going out on a limb. This is the same group of companies that have led for years in underwriting difficult issues such as diabetes, epilepsy, heart disease, etc. They are on the cutting edge of prudent, fair underwriting. They are the companies that are making a difference in groups of people that have been shunned for a long time.
Bottom line. Spread the word. Fair rates are available for the less than perfect insurance risk. You and I may not get the rates we see splashed on TV, but in most cases we shouldn’t be looking a decline letter either.
April 14th, 2008
I have often written about the surprises that come with life insurance exam results, from the fairly benign slight elevations in cholesterol to the alarming large elevations in PSA results. The surprise should really come as no surprise because the person who gets annual physicals is today, more the exception than the rule.
We all have busy schedules and for those without health insurance, the idea of “wasting” a few hundred dollars on a physical when we feel just fine just doesn’t seem to make sense. The problem is that the insidious side of health issues is that, quite often, you can feel just fine until you don’t and then it’s too late. Remember, with the big problems like cancer and heart disease, caught early is the key to beating it.
This is where health fairs bridge the gap. I know Colorado is not an exception and that health fairs are held all over the country. Their goal is to offer a way to skirt the excuses and get a health check that could find something early and help save lives. They generally happen on the weekend, away from busy schedules, and they run the gamut from free to cheap for a tremendous amount of information.
Next weekend is the health fair in our area and as always, my wife and I will attend. While I’m not shy about beating up the general population over their willingness to ignore annual physicals, the truth is that I am part of the general population. Our annual health fair has helped me to be more proactive about health where I too would be among those who really don’t want to shell out hundreds of dollars for blood tests.
Bottom line. Feeling good and being healthy aren’t necessarily synonymous. An annual checkup is a great idea and with health fairs, schedules and economics don’t have to be barriers. Don’t get surprised on a life insurance exam when you can be on top of things and know going in what the state of your health really is.
April 13th, 2008
In a post some months ago I was sharing some of my new found knowledge about ultra fast CT scans and their viability and dependability in detecting clogged arteries in the heart. Just to refresh a bit, the ultra fast CT scan hangs it’s hat on the ability to detect calcification in the veins and arteries.
The problem has been that the heavily marketed test
doesn’t seem to be as accurate as it’s wealthy marketers would like everyone to believe. The life insurance case I was working on at the time involved a person who had a very high calcification score, but after a complete cardiac workup including a catheritization, he was given a clean bill of health. The score was high but there was no clogging of the arteries happening.
That was kind of the big rub. The test is touted as a non invasive procedure to detect coronary artery disease, but its’ inherent inaccuracy leads to invasive procedures to determine if the results were accurate. Dr Joseph Mercola kind of summed up one view of this whole thing on his website, www.mercola.com, like this. “Every time a new non-invasive heart test is invented, it is hailed as bringing us one step closer to the day when invasive tests will no longer be necessary. And yet, as time goes by and the new non-invasive test comes into common use, more and more invasive tests end up being performed. This is not a mysterious or inexplicable result. It is entirely predictable.
So now I am working with a client who has high cholesterol and LDL rates and has an ultra fast CT scan result that has a calcification score of 0. Nada! I shopped this for him, and the companies that ripped the other client up due to his high score, refused to give any credit to this poor fellow with a score of 0. Not too surprising, the one company that discounted the impact of the first guy’s high score, gave this client credit for his low score. A thinking underwriting team. Keep those people on the payroll!
Bottom line. The test still hasn’t been scored when it comes to ultra fast CT scans. Before plopping down the hundreds it takes to get one you really should do some homework.
April 9th, 2008
I’ve mentioned before that there is a problem in the life insurance business. Pure and simple, it’s greed. Agents are so protective of a potential sale that they will actually tell a customer they are uninsurable, rather than admit they are the wrong agent for the job and lead them in the right direction. This is particularly true of captive agents whose world revolves around one company and that company’s underwriting opinion.
Very few days go by without hearing from people who are desperate to find affordable life insurance. They have been declined or told they are uninsurable because they have bipolar disorder. They’ve been told they will never get insurance because they’ve had a heart attack or breast cancer. I’ve had clients who are never called back by another agent because they admitted they had been through alcohol treatment or are have type 1 diabetes..
Agents actually tell these people “you will never get life insurance”. What an insanely unprofessional thing for an agent to do. I can only imagine how many clients just give up and leave their family without protection because some lame excuse for a life insurance agent didn’t have the guts to just tell their client to seek out a more experienced independent agent. You can Google up an independent agent in .23 seconds that has experience in exactly your health issue.
If you talk to an agent and they declare you uninsurable without running your information informally through several underwriters, they are either captive or incompetent. If they say they’ve shopped it and you are simply uninsurable and they don’t talk to you about guaranteed issue life insurance, they are captive or incompetent.
The bottom line is that agents very often declare you uninsurable because they aren’t knowledgeable in your impairment or are too lazy to work an impaired risk case. You know what the issues are with your impairment, and if an agent isn’t asking the right questions, you know you’re with the wrong agent. No one said it’s easy, but quoting Rich Fuller from Special Risk Services, an impaired risk general agent for 30 years, “Anyone can write insurance on the super healthy, but the reward is placing much needed insurance for someone who has suffered severe health problems”.
Bottom line. Never take uninsurable as an answer. Do an internet search for an agent with the expertise you need. Find someone who knows the questions, knows the answers and knows where to shop your business, and just as importantly, where not to shop your business.
April 8th, 2008
People act shocked and amazed when they find out they don’t get those life insurance rates advertised everywhere. I think somewhere inside they knew it would happen because those are non smoking rates and they smoke. And all that flashed fine print on the insurance ads can hardly be seen through the smoke. Surely though, they’ve seen the warning on the pack that says smoking has NOT been linked to great life insurance rates.
Even the companies that are actively seeking smoking clients will charge twice as much for a preferred smoking rate as they will for a preferred non smoker. Some are three times more and there are a few trying to send a message with rates four times higher. I’m thinking the underwriters at those last two sets of companies may have read somewhere that there are statistical links between smoking and cancer, smoking and heart disease, smoking and etc, etc, stroke, etc, etc………..
Some life insurance companies will allow a person, who has smoked for 20 or 30 years, quit for 12 months and get preferred non-smoking rates. I know they say that damage from smoking starts to reverse itself shortly after you stop smoking, but all the way to preferred in one year. I’m all for people getting great rates, but…. it seems to me that the companies are probably charging non smokers too much to start with if they will allow that kind of underwriting.
Bottom line. I suspect there are smokers and ex-smokers who might not jump on to my bandwagon. My suggestion. Quit smoking and go grab those preferred non-smoker rates before those companies come to their senses.
April 7th, 2008
My vote for the biggest rub in life insurance underwriting is weight. Easily the most disgruntled life insurance client is when they are told that their insurance is going to cost more because they guessed their weight wrong, or they weren’t really 6’2, but 6’1 1/2 (which examiners round down, not up).
Insurance companies have build charts and they really do stick to them, especially when it comes to giving the coveted preferred plus rates. A good independent agent might be able to get an underwriter to forgive a pound or two if all other risk factors are good. Generally speaking though, if you don’t fit into the height and weight it takes for a certain rate class, well, that’s life. More weight. Less height. More money!!!
OK, let’s talk about how to work the system. Find out what your REAL height and weight are before you talk to an independent agent and don’t fudge. Don’t round yourself 1/2″ up. Tell the agent exactly how tall you are. Don’t round your weight off to the nearest 10 pounds. Tell them exactly what you weigh and when you checked it last. Tell them if it historically fluctuates and if it’s not big deal to shed a few pounds before the exam.
I swear if you asked 100 people what their weight is, 95 of them would come back with a round number like 170#, 180#, 200#, 250#, etc. 5 will provide a number that seems like they must know, like 193#. 2-3 of them actually will know what they weigh. This is particularly pronounced when people have let their weight get out of control. The higher their weight goes, the less they really check and the more likely they are to be off on their guess. When it comes to those who fit into the obesity category, it is not uncommon for their estimate to be off by 25# to 50#.
The impact on life insurance rates can be dramatic. There are companies out there with reasonably liberal build charts. This is why an independent agent is so important. He will steer you to the right company and away from the wrong company. If you are off 15#, it may well be that you would have been better off going to a different company.
Bottom line. Garbage in, garbage out. Your agent can only provide quotes that are as accurate as the information you provide.
April 6th, 2008
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