Posts filed under 'A1c'
There are plenty of people who would argue that 2009 could have been flushed down the toilet and not missed, and my prayers go out to all of those whose lives were derailed by the recession. For those I wish a dramatically better new year.
But, when it comes to life insurance underwriting of the impaired risk variety, it was a year that started strong and improved from beginning to end. When I started working with clients with bipolar disorder two years ago my goal was to simply find a few good companies that were open to the idea of approving policies. Nothing earth shattering, just approvals. Working with about eight different companies the picture soon started to come together that not only were approvals possible, but given certain criteria, very good approvals were not out of the question. The criteria below seemed to be the crux of what meant the most to those companies that were willing to admit that not everyone with depression or bipolar disorder was an imminent mortality risk.
1. Someone who has not been hospitalized for bipolar disorder other than for diagnosis?
2. Someone who has not attempted suicide or had bouts with suicidal ideations?
3. Someone who is compliant with their treatment, both medications and regular followups?
4. Someone who is leading a stable family life or social life?
5. Someone who is exhibiting a stable work life?
6. Someone who is not on disability for bipolar and does not have issues with drinking or drugs? If there’s a problem here, then the answers to 3, 4 and 5 are no.
7. The best rates came when multiple meds were not involved and anti psychotic drugs were not part of the treatment plan.
We continued to see some leeway creep into underwriting for type 2 diabetes. One company stepped up and decided to stretch underwriting of late onset (post age 60) diabetes within certain guidelines to include, absent other risk factors, preferred plus rates. While age of onset is still a big factor for anyone with diabetes, compliance and control as measured by the A1c was still the benchmark with 7 or below being favorable and below. We saw one false positive when someone at Transamerica apparently misunderstood what they heard at a meeting and announced to the world that Trans was no longer looking at early onset as a negative. Not sure where they are working now, but hope it works out better for them.
Bottom line. We always have been able to and still can get the best rates in the country for the perfectly healthy, but for the rest of us it’s all moving in the right direction as well.
January 4th, 2010
I written several times about a major term life insurance company that took the unprecedented step of saying they would allow, in the absence of other risk factors, their preferred plus rate class for some people over 60 with type 2 diabetes.
Their only other criteria? They had to have been diagnosed within the past 5 years and have an A1c of 7.0 or less. I’ve seen several approvals come through on this with other agents I know, but hadn’t had a chance to actually present an application until recently. My client is 63, had an A1c of 6.9 on his insurance exam and his doctor has had him on diet control for the past few years since they originally ran across high glucose on another insurance exam.
We already had the medical records on this case, so with the exam and labs in hand it was off to the underwriter who swiftly hit it with a table 2 approval. I’m thinking this guy didn’t get the memo from the chief underwriter so we questioned why my client wouldn’t qualify for preferred rates.
His answer was that my client had never really been diagnosed, although his records clearly show a link between his first elevated glucose and being put on a specific diet. He said that my client wasn’t really being treated, as in he wasn’t taking any prescribed medicine. As far as I know diet control of diabetes has always been considered treatment. At least the people that are on the diet feel like they are being treated and if the result is that the doctor is expecting some change in the glucose level, well, it kind of sounds like treatment….
And then he blurts it out! He thinks it’s stupid that an insurance company would make that kind of an offer. He states that there simply isn’t the mortality experience to back it up. Furthermore he stated that there was nothing inherently fair about whacking someone one rate class for well controlled high blood pressure and not for well controlled diabetes.
I have to admit that I don’t disagree with what he feels, but the guys signing his paycheck are paying him to big bucks to uphold their wild marketing ideas. Fortunately there is some check and balance in the underwriting world. If a rogue underwriter doesn’t want to go with the flow perhaps his boss will remind him which way feces flows.
Bottom line. I think we will prevail on this and I’ll post the end result. In the meantime the door does still appear to be open (just route it around the underwriter I got) for well controlled 60+ year old diabetics to get rates that are less than 1/2 of what they would get through any other company.
August 13th, 2009
Wanted. 60+ year old type 2 diabetic. Diagnosed in last 5 years. Good control with A1c 7.0 or better. No complications. You have won the prize.
I’ve been working with the diabetes community for a long time and never thought I would be able to announce that a company would offer their best rate class for someone with diabetes. Hello! Three approvals later I am ready to call this more than just an anomaly. It is a genuine breakthrough and the word needs to get out.
This highly rated company really means it and they aren’t pulling any bait and switch games. They have studied the mortality risk in this group and are convinced that it is no worse than a person the same age with no health issues. This is bigger than huge, cutting the potential cost for life insurance more than in half compared to what used to be the best case. For some in this category these rates could end up being a third or a quarter of what you’re being quoted through other companies.
The even better news here is that with this breakthrough underwriting, there is hope that further mortality studies will open up even more opportunity.
Bottom line. If you fall into this category and need life insurance or need to replace overpriced insurance you have in force, don’t wait. If you know someone in this group, get the word to them. Preferred Best rates! It just doesn’t get any better.
June 10th, 2009
Usually the first shot in the arsenal of ways to deal with type 2 diabetes is diet and exercise. The great thing if it works is that the diabetes can be controlled or beaten, a life style changed, and absolutely no negative side effects.
The American Heart Association has released guidelines for exercise for those with type 2 diabetes that look strangely similar to the guidelines they recommend for everyone else who wants to stay heart healthy. The difference is in the urgency. 70% of deaths in type 2 diabetics are heart related. It is a disease that just takes no prisoners among those who don’t fight back.
I’ve shared in previous posts how our current economy is hitting those with chronic diseases hard, often leading to self adjusting medications to keep the cost down. The two and a half hours of moderate exercise that the AHA recommends weekly is a free way to take back some of the control that the recession has taken away. With obesity being the leading cause of type 2 diabetes and heart disease being the leading cause of death from type 2, obviously anything that can be done to work on weight and strengthen your cardiovascular system is going to be in your favor. The truth is that if you can manage to take control of the obesity issue, you can often kick the need for diabetes medicine altogether.
One of the biggest concerns with diabetes is its’ progression, both where it comes from and where it leads to and the mortality risk associated with the health issues along that whole path. If in the beginning is obesity, then underwriters are not only looking at diabetes, but a host of other health issues including heart disease, high blood pressure, stroke and cancer. On the other end of the journey uncontrolled diabetes can cause kidney damage, eyesight problems and heart disease.
Having said all of that it’s hard to imagine that anyone with type 2 diabetes would be approved at all for life insurance, but like most chronic diseases, if well controlled and taken seriously, the mortality risk and risk of complications is dramatically reduced. For the best underwriting success with diabetes an underwriter would like to see onset after age 50, an A1c of 6.5 or under, and no other collateral health issues. Very often this can mean standard or better rates are available. If a person is age 60 and has had diabetes for 5 years or less, at least one company has indicated their best rate class is available.
Bottom line. Just like everyone has been telling us forever, eat right and get plenty of exercise. The benefits go way beyond good life insurance rates with demonstrable changes in health and lifestyle making quality of life what we really all wish it would be.
June 8th, 2009
For years there has been plenty of debate in the medical community over the best measure for diagnosis of diabetes, or more specifically, which test gives the most accurate assessment for that diagnosis.
For years life insurance companies have used the A1c as a measure of whether a person is pre-diabetic, diabetic, and if they are diabetic, how well controlled the situation is. The reason they have used and I think the most valid argument for the medical community to use it as a baseline is that, simply put, it is less volatile than glucose testing.
A fasting glucose test, a snapshot at best, only tells the doctor what is going on at that very second in time. It is not unusual for someone who is undeniably diabetic to be able to produce stellar fasting glucose tests. On the other hand with the A1c, it is virtually impossible to miss the fact that, on average, a person’s glucose is running well above guideline normal.
Now with the major world diabetes organizations leaning toward using the hbA1c as the default test for the medical community, patients will have quicker, more accurate diagnosis which will lead to earlier treatment intervention.
As an aside, it will also lead to a little less fuss between insurance underwriters and medical practitioners. If adopted, the guideline discussed of making an A1c of 6.5 the guideline for diagnosis of diabetes will also match up with most insurance companies that work well with diabetes as their cutoff for their best rate class offered with the disease.
Bottom line. I think anyone that has been around diabetes for long knows just how whacky single glucose readings can be. Everyone will find adoption of the A1c to be a prudent move.
June 5th, 2009
A month or so ago I talked about a client of mine who, over the course of 4 years, has been working with me to get his rate down from the very first approval we were able to get through Empire General at a table 8, to a just approved standard plus rate with Banner Life.
I hold this client up as an example of how, when a client is really involved with the process, positive things can happen. This is a guy who has provided study results, pathology reports, and gone out of his way to get a checkup that he wasn’t even due for, simply because he knew that it would help our battle to win him better rates. We were able to improve the rate each year because of his willingness to do whatever it took. His rates were over $12,000 a year. They’re now under $4,000.
In contrast are people who contact me for insurance quotes and know little or nothing about their medical situation and for sure aren’t going to call their doctor or run by the doctor’s office to get a copy of labs or a pathology report or a copy of a stress test or a sleep study. The act as if I am imposing on them to ask for more information than they can provide me right then and there when, all I’m really asking for is exactly what an underwriter needs.
If I am providing a quote for someone with diabetes, I need to know their A1c. If it’s a history of cancer I need to know the stage and grade. If it’s heart disease or if someone has had an angioplasty or bypass surgery, I need a copy of their stress test so I know what their ejection fraction is. With sleep apnea, a copy of the sleep study is needed like all of those other things, to ensure that the quote I provide is accurate.
I can’t tell you how many times I’ve heard over the years, “Well, if it’s going to be that much of a hassle, just forget it.” I always wonder if they then turn around and tell their wives that they would have bought life insurance but the agent wanted me to call my doctor’s office and it was just too much hassle.
I suppose I am beat out of some of this business by agents who don’t hassle anyone and just quote what they want to hear, or just shoot from the hip without all the facts, but the truth is that asking for that information serves two purposes in the process. First, if the client provides the requested information, it ensures an accurate quote and generally means that I can expect them to stay involved through the application process. Second, if they don’t take that small part in their own quest for life insurance, at least in my experience, they won’t end up being a cooperative client through the rest of the application and they also have a higher lapse rate than those who really get involved.
Bottom line. Not everyone gets preferred plus rates and those with serious health issues need to find a good independent agent and get involved in their own destiny if they don’t want to over pay or explain to their spouse why they are just going to go without.
May 5th, 2009
It’s been several months since there was any major movement on the life insurance underwriting scene for those with type 2 diabetes, but a major company today shattered that trend by announcing that are willing to approve at preferred plus rates within certain criteria. This certainly falls into one of those news worthy things that I would love to share with the American Diabetes Association, but they’ve made it clear that sharing good news is selling. DLife and TuDiabetes should pick up on it through Twitter.
The bad news is that it isn’t going to be for everyone. The good news is that a company would underwrite this aggressively for anyone with diabetes. It’s simply unprecedented.
From their head underwriter I got this underwriting synopsis, “60+ yr old Type 2 Diabetic, duration 5 years or less. Excellent control as measured by the A1c, on oral med or diet treatment. Balance of medical history favorable and no associated complications. All other factors fit Super Preferred. Case approved Super Preferred.” And while one case doesn’t make a trend, we have had one case approved under this scenario and all indications are that this will be their stance for the foreseeable future.
Being the careful kind of guy that I am I asked for clarification. I asked for clarification on what is considered “excellent control”? Answer was 7.0 A1c or less. How long does that A1c have to be at that level to qualify for best rates? At least six months. If the client doesn’t qualify for super preferred but meets all other criteria, how is their rate class determined? If the diabetes falls within the age and control guidelines given, they would qualify for whatever rate class they would get in the absence of the diabetes.
I know all of those younger than 60 will be crying foul, but keep in mind that we have been very successful at getting younger clients better than standard approved rates provided the control is excellent and there aren’t other risk factors that would bump them higher. It gives me hope that better news may come soon for those under 60.
Bottom line. We need to take this for what it is, great news. Call a knowledgeable independent agent today.
May 4th, 2009
I certainly am not going to minimize anything about the swine flu outbreak and if it meets the WHO definition of a “Pandemic” it’s OK with me if they call it that. So I’ve often referred to the type 2 diabetes epidemic and wonder if it would really be more appropriately called a pandemic.
While the outbreak or onset hasn’t necessarily been sudden, it has certainly become widespread and impacts and kills more people. Whatever you call it, and by the way WHO calls it an epidemic, the fact that there are about 180 million people with type 2 diabetes worldwide today and that is expected to double in the next 20 years, is significant. Over a million people die annually from complications of type 2 diabetes. As I wrote in a recent post, that number is likely to rise in these tough economic times as those with diabetes try to balance budgets with medicine.
From a life insurance standpoint the only good news in all of this is that as the numbers increase, education and treatment options are becoming more available and hopefully more affordable. Underwriters really don’t care what it’s called though, but focus squarely on the mortality risk. Unfortunately those at the bottom of the economic ladder, the people who arguably need life insurance the most, are the group that is most at risk and also most likely to be financially unable to afford the type of treatment it takes for good control.
The answer for most, at least during this recession, will be to lower their expectations on the amount of life insurance they would like to carry. The truth is that in all cases something is better than nothing.
Bottom line. The fact is that life insurance is available at reasonable rates as long as your diabetes is well controlled, A1c under 7.5. As control worsens, the price goes up and there is a point when your A1c is over 9 when underwriters may choose to decline your application until you have resolved the situation.
April 28th, 2009
This is a verbatim copy of the life insurance information page that the American Diabetes Association provides its’ members with. It’s important to note that much of what was written was put in place when a company called US Financial was still in business. They truly did stand out in diabetes underwriting, but they’ve been gone for 3 years. Comments from me are in bold print.
Once a person is diagnosed with diabetes, life insurance policies sold within the United States can become unaffordable or unavailable. This is because life insurance policies are allowed by state and federal law to “rate” or charge a premium based upon an applicant’s health status. In addition, a plan can choose to not provide a policy based upon an applicant’s health status. I just find this a bizarre way to start a discussion on diabetes and life insurance. Policies could be come unaffordable or unavailable, but in all likelihood they won’t. Federal law has absolutely nothing to do with insurance rate classifications. Stating that a plan can choose to do something means absolutely nothing to someone who’s not in the business.
Even so, it is possible for many people with diabetes to find affordable life insurance policies within the United States. You just have to know where to look. Certain life insurance companies, or carriers, specialize in selling policies to people with chronic health conditions like diabetes. US Financial is really the only company that ever specialized in impaired risk. Others have been good at certain aspects but their underwriting has never been truly consistent. That is why using an independent agent is so important.
To find the best life insurance policy for you, please consider the following:
* A major factor in the cost of life insurance policies for people with type 1 or type 2 diabetes is how well they manage their diabetes. If you have a lower A1C, good blood glucose control, lead a healthy lifestyle, and do not have complications from diabetes, chances are your rate will be more reasonable too. Age of onset is huge also. Especially today with type 2 diabetes occurring earlier due to the epidemic of obesity. The reason that age is so critical is that diabetes, given enough time even with good control, does damage.
* Find an insurance agent that is experienced in obtaining policies for individuals with “impaired risk” — they will know what carriers may offer you a policy and which one(s) may not. You will know a knowledgeable and experienced agent by their questions. If they don’t sound like they understand diabetes, find another independent agent and start over.
* Apply for a policy with a life insurance carrier that uses “clinical underwriting” — a process that looks at your total health, not just what health conditions you may have. US Financial is the company that coined the phrase clinical underwriting and they are the only company that ever truly utilized it. Again, out of business for 3 years.
* Shop around — on the internet, by phone, or through referrals from family and friends. Becoming your own advocate will help you to find a life insurance policy that best fits your needs. You should shop for an independent agent that you trust knows what they’re doing and let them take over the shopping duties. A good agent can cut the weeks worth of your time in just a few days.
* Never take no for an answer! Just because one company rates or declines your application does not mean that another company will not look at you more favorably. Can’t argue with that. There are a couple of thousand companies that sell life insurance in one form or another. There about ten that are truly good at what they do. If you got a decline, there is a very high likelihood that it was because the wrong agent took you to the wrong company.
Bottom line. My personal opinion is that the best suggestion that the ADA had in this whole thing is to “be your own advocate” since they are quite obviously not interested in taking on that task.
April 14th, 2009
I had a client who was just declined due to lab results on his insurance exam. This took us both by surprise since he had indicated that he had a physical just 6 months ago and his doctor had told him everything was fine.
Unfortunately, because he told me that that everything was fine I didn’t see a need to see the set of labs before we applied. Now “in retrospect” has hit us both in the rear. When I called today to tell him about the decline which was due to an elevated PSA and an elevated A1c, we had a chance to discuss those two issues and he remembered that the doctor did make mention of both of those, but dismissed them as irrelevant.
The doctor actually retested the PSA after he got an initial high reading and informed my client that the second reading was high also, but not high enough to worry about. An elevated PSA is indicative of either an enlarged prostate or prostate cancer. I’m no doctor, but it seems to me that it might be a prudent exercise on behalf of the patient to do some testing and determine which of those two is increasing their PSA.
The elevated hbA1c was at 8.2, which means his average glucose levels are in the 180 range. He said his wife has type 2 diabetes and he has messed around checking his glucose occasionally and it is usually in the 120-130 range. So if his lows are around 120 and his average is around 180, there are plenty of 240+ levels happening in his life. His doctor’s take on the elevated A1c…..he really doesn’t believe in it!!!
My client, now armed with the labs from his insurance exam, is seeking a second opinion. We have some work to do before he will be ready to apply for life insurance again, but I suspect we’ll be back after it in six months to a year.
Bottom line. Learn to question things that don’t add up with your doctor. Like, “Doctor Smith, if you tested my PSA twice and it was out of the normal range both times, why is it that I shouldn’t worry about that? Can you show me some documentation telling me why that goes in the don’t worry column?” And, “Dr Smith, if you really don’t believe in the hbA1c test, why did you have it run?”
April 6th, 2009
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