Posts filed under 'angioplasty'
I think on some level we all carry a bit of denial along with us. It’s probably a chomosomal kind of thing, like there are x, y, z and denial chromosomes.
Unfortunately for those most affected by denail there is bad news from life insurance underwriters. Probably the best example of this is the underwriting treatment of those who really don’t believe the link between smoking and heart disease. There is probably nothing that is more likely to lead to a highly rated policy or with most companies, a decline, than someone who continues to smoke after they have had coronary issues.
Literally the best case would be if someone had a one vessel angioplasty with no heart attack and a great followup history of stress tests, complicated only by the fact that they still smoke. In the absence of smoking a case like this could get as good as a standard rate, with the norm being a lightly rated approval. Add in smoking and most companies will decline it. Those that do approve it will approve it at highly rated prices.
Why the big underwriting slap in the face? Well, the beginning and the end of the argument go like this. Smoking is the <a href=”http://www.mamashealth.com/Heart_stat.asp“>leading cause and accelerator</a> of heart disease! Why should life insurance underwriters cut you a break when you are knowingly doing yourself damage? You don’t really have to answer that because the answer is that they won’t.
So, what should you do if you have had cardiac issues and smoke and want life insurance. I recommend you apply and if you get approved, put as much in force as you can comfortably budget, then quit with the denial stuff and quit smoking. When you are 12 months out from the last nicotine entering your body, reapply and watch your rates be cut dramatically to something around 1/3 of what you were paying before. “Well, why not”, the denialist asks, “just quit smoking and wait a year and then I won’t have to pay higher prices for that period?”
Bottom line. Once you learn denial it’s a hard thing to shake. The reason you don’t wait a year is because you will feel so stupid leaving your family behind with no life insurance. Do what you can now and do more after you’ve corrected your bad habits.
January 3rd, 2009
There isn’t any question that given the clear choice between suffering a potentially fatal heart attack and having the artery opening procedure called angioplasty, the prudent thing to do is to stack the deck in your favor and open those arteries.
But there is a serious question about the use of angioplasty as a preventive measure. In other words, if you are not in imminent danger of a heart attack and arteries that have begun to clog are treatable with medicine, is the risk of an invasive procedure still prudent and reasonable. Recent studies have shown that there appears to be enough inappropriate recommendations for the procedure that the American Heart Association and others will be releasing new guidelines within a few months regarding when an angioplasty should be set aside for treatment through cholesterol lowering and clot busting drugs combined with exercise.
Medically this is a huge issue. From a life insurance standpoint it can make the difference after the diagnosis of how soon a person can get life insurance and how much they will pay. If a person is found to have blockage that is successfully treated medically and those results can be substantiated on a subsequent stress test they could be looking at standard rates, possibly better, within six months. If they have an angioplasty, whether it was needed or not, it will be at least a year and a good stress test and then the rates will generally be higher than standard rates.
The good news is that, given a good stress test, either way you would be insurable. The bad news is that an over zealous doctor might do more damage than just handing you a large cardiologist’s bill.
Bottom line. Second opinion, second opinion, second opinion……unless you are having a heart attack.
November 17th, 2008
For as long as there has been life insurance and heart attacks there has been misinformation about the impact of the event on future ability to obtain the insurance.
Two of the most common myths are that 1. If you’ve had a heart attack then you are simply toast and will not be able to get life insurance and 2. There is a five year waiting period after you’ve had a heart attack before you can apply for life insurance. If this was a multiple choice test the answer would be 3. none of the above.
With heart disease testing and detection improving all the time and with post heart attack treatment doing the same, the chances of having a heart attack and the actual damage from any heart attack have greatly diminished. New testing helps detect blockage early enough that often cholesterol lowering and clot prevention drugs keep patients from having any procedures at all. If blockage has reached a point where there is potential for damage, state of the art angioplasty or bypass surgery can be performed.
If blockage is caught early enough to treat with medication there is a good chance that, given no other risk factors, rates can be as good as preferred or preferred plus soon after treatment has started and a positive stress test has shown that the treatment is working.
If there is an angioplasty or bypass surgery with no heart attack, insurance can be applied for as soon as 6 months to a year after the procedure, again, as long as there has been a stress test completed that can address the current condition of the heart and any arterial blockage. The rates that can be approved will depend on an applicant’s age. Like diabetes, age of onset is a real hang up with underwriters. Anything prior to age 50 will incur a higher rate than post 50 and prior to 40 will be rated even higher.
If there has been a heart attack followed by angioplasty or bypass surgery, the same 6 months to a year and a good stress test applies, but you can assume the rate will be higher simply because a heart attack causes heart muscle damage that is often not reversible.
Bottom line. Heart issues don’t deal a death blow in most life insurance situations. It may make it a little harder work for your agent and you, but in most cases realistically priced insurance should be available through a knowledgeable independent agent.
October 31st, 2008
You don’t buy life insurance, rather, you apply for it. Because there is an application there should be a common understanding that there is a chance that your application will be rejected. The industry term is decline.
While declines are far more the exception than the rule, there are some common threads found in declines. These same threads are often found in applications that are asking for preferred rates and come back at standard or higher rate approvals.
I know. You’re used to me eating the face off of clients for their lack of knowledge or lack of candor when it comes to their medical history, but today we start with the insurance professional, the agent. In most cases a knowledgeable independent agent will know enough after an initial interview with you to know if you will be approved and within a reasonable margin of error (not politics, lab results), they should be able to quote you the rate class you will be approved at.
In the cases where there are health issues a prudent agent will take all the information and send it out for trial offers from underwriters. Expect a good agent to dig for as much information as they can get because insufficient information will lead to an inaccurate quote and an unsatisfactory outcome. I have had people tell me that I ask too many questions or even tell me “that I don’t need to know that, just quote me”, but trust me, you want an agent who knows what questions to ask to get to the underwriting bottom line.
Let’s say you have diabetes. I can ask you what your most recent hbA1c is up front and if you don’t know it, insist that you call the doctor’s office and find out what it is or, I can quote you a best case scenario and when your hbA1c comes back high in your medical records we can have a friendly chat about why the cost of your insurance just doubled over what I quoted. Or I could call you to explain that you were declined. Some wise guy once said “knowledge is power” and when it comes to successfully coming through with good life insurance rates in the face of health issues, it most certainly is true.
The agent has a professional obligation to be a fact finding animal. It’s the best way to serve clients. Clients, if they want the best possible service, have an obligation to be accurate and forthcoming to the max. Don’t ask, don’t tell, is not the relationship that wins in insurance underwriting. A recent example would be a client who answered no to chronic respiratory disease because I didn’t ask them about reactive airway disease. Get real!
Truth is that even if I ask someone to disclose everything that has ever been a health issue, in their mind a heart attack might not be a health issue because they lived through it and after the five vessel angioplasty their doctor said they are just fine. Would you take your car into a mechanic because it’s running really bad and just neglect to tell them that because of the price of gas you tried watering that $3 a gallon stuff down a bit?
Bottom line. Garbage in, garbage out! If the agent doesn’t do their job the end result isn’t what you expected and conversely, if you aren’t completely forthcoming with the agent, don’t expect them to pull off a miracle for you.
October 29th, 2008
I think I’ve been very clear over the years about unexplained information in medical records and how life insurance underwriters deal with it. They ask questions!
Sometimes the mystery information isn’t relevant once it is explained. Sometimes the information doesn’t even pertain to the patient. I think I’ve shared this before, but several years ago a client was declined after a review of medical records due to not admitting a history of heart disease.
After calling the client with the news, she was adamant that she had never had any kind of cardiac event and had never consulted a doctor for any potentially cardiac related symptoms. After speaking to the underwriter, he said that the records clearly mentioned the word angioplasty. He gave me the page number and said the word was circled. I passed this on to the client who pursued a review of her medical records. She and her doctor were finally able to nail down the reason for the note. It seems she had a friend who was going to undergo an angioplasty and she had asked the doctor to explain what it was. As he explained, he doodled and subsequently left the word angioplasty in the records of someone who didn’t even know what it was.
Doctors are notorious for doodling or writing down some thought with no further explanation. And generally I become the messenger, being shot on sight because the underwriter is asking for clarification. It means homework for the potential insured and while some don’t mind, most feel as though they are being asked to do the work that someone else should do.
This came to a head with one client the other day when I called and asked if she could get a letter from her doctor explaining why he had circled a certain condition on two separate visits, something not done on any other visits. Without clarification the company was willing to offer coverage at a higher rate than originally quoted. With an explanation we could likely have had a policy issued at the same rates originally quoted. She refused. She said it was obvious to her and if it wasn’t obvious to the insurance company, then they were just trying to gouge her for additional premium. The circled condition with no explanation needed clarification. She shot the messenger and withdrew her application.
Bottom line. Underwriters have to try to make sense of your medical records. If you think that’s easy, you’ve either never been sick or never looked in your medical records. If an agent comes back to you asking for clarification, it’s not because the insurance company wants to raise the premium, but rather because they are looking for an explanation that would help them avoid that.
August 14th, 2008
Early on in my work with cardiac patients needing life insurance I learned to ignore what they remembered their cardiologist telling them about their prognosis, and just dig for facts. The most important fact that we needed uncovered and on the table was the amount of damage the heart muscle incurred.
Cardiologists, as near as I can tell, are taught in school to tell their patients that, having survived a heart attack or angioplasty or bypass surgery, “that they now had the heart of a much younger person”. That would be nice if it was true. A brush with the leading cause of death in men somehow does not equate to you somehow, suddenly, having the heart of a much younger person unless you happened to have a transplant in the mix and literally did have the heart of a younger person.
The measure of strength of the heart and therefore the measure of how much damage has occurred is generally drawn from one of the results of an imaged stress test, the left ventricular ejection fraction (LVEF). It is literally a measure of how effectively the heart is able to move blood out of the left ventricle, the heart’s primary pumping chamber. The heart’s function is to pump blood and if that ability is impaired, the rest of the body that is dependent on that flow suffers to some extent.
Clients often get weary of my need for the facts, but it is those facts that lead to accurate life insurance quotes and ultimately a successful search for the best possible life insurance rates. When I don’t take the cardiologist’s rosy synopsis without seeing a copy of the last stress test I am often perceived as “asking too many questions”. I am told more often than I can count that “other agents will give me quotes without all of that”. What life insurance seekers don’t understand is that ultimately the underwriters at the insurance companies will be looking for the very information I asked about and, if they deferred to an agent who wasn’t so bothersome up front, the chances of the end result, the approval, being the same as the beginning, the quote, is very slim indeed.
Underwriters evaluating risk in cardiac cases want to know your age when the condition was first diagnosed. They want to know what happened and what was done. They want to know how many vessels were affected. They want to know how often you see your cardiologist and when your last stress test was. (I just had one client who told me it was two years ago, which is kind of a hinge time for underwriters. Less than two years is good, more isn’t. So I asked him to check and he came back and said it was actually 5 years ago. My how time flies when you are ignoring your health and your cardiologist’s recommendations). They want to know your LVEF. If it is more than 50% you are still in the game. If it is less than 50% you had better hope that some offsetting factor will lead an underwriter to make a highly rated offer. That would be good news as most often less than 50% is an automatic decline.
Bottom line. Most doctors aren’t going to do it for you, so educate yourself. If you can’t answer the question, “how much damage was done”, get copies of your tests and Google the results and find out what they mean. Make a list of questions and demand answers. If a run at life insurance is in your future, seek out the independent agent that asks the most questions, not the least.
July 30th, 2008
One of the challenges we face each week is finding affordable life insurance for people who have suffered a heart attack, or have undergone angioplasty or heart bypass surgery after having chest discomfort due to blocked arteries. The good news! The folks we are helping are alive and with the often hidden heart problem revealed, they have a greater chance of avoiding having a major cardiac event in the future that could end their lives. They have a new lease on life.
Heart attack survival has been on the rise for several years due primarily to advances in rapid response treatment and more aggressive treatment to open blocked arteries. The playbook has been rewritten in the past decade concerning how emergency response crews and emergency room staff react to heart attacks with more emphasis being put on rapid use of clot busting drugs and quicker intervention through angioplasty.
Another boon to survival rates has been the acknowledgment that post cardiac event exercise plays a huge role in how quickly a patient recovers and their chances of not having a recurrence.
From a life insurance perspective there are several points for optimism. First and foremost, you survived. Whether that is due to your event being a mild one or due to more advanced and aggressive treatment, the result is the same. Second, the damage your heart incurred was likely less than it would have been in the past and the amount of damage to heart muscle is a carefully viewed measure in underwriting. Third, the long term chances of not having a recurrence have improved due to recommended lifestyle changes and newer cholesterol lowering drugs so another underwriting challenge, avoiding chronic coronary artery disease (CAD), is avoided.
How long does it take to get good offers after a cardiac event? While there are exceptions, generally you will need to be one year out from the event and you will need to have completed an imaged stress test, either an echocardiogram or a thallium stress test.
Bottom line. While you will likely never see preferred plus rates again, there is every reason to believe that standard to slightly substandard rates will be available. In layman’s terms, you should be able to obtain affordable life insurance.
July 21st, 2008
Any time I am working with a new client who has had serious health issues, there are specific pieces of information I need that are essential to my ability to provide an accurate quote. On rare occasions people will know the critical information, but most of the time it has been filed in their minds as doctor talk and left to the archives of their medical records.
With cancer it is imperative to know the specific type of cancer and the stage and grade of the cancer. With diabetes it is imperative to know the hbA1c, a long term measure of glucose levels. With the cancer the information is contained on the pathology report and in the case of diabetes, the most recent full blood profile.
Whenever there has been a heart attack or coronary artery disease (CAD) that leads to either bypass surgery or angioplasty, the critical information is contained on a stress test. Generally a stress test will be done 6-12 months after a cardiac event just to check on the amount of damage that was done and how well the heart is performing.
Usually either a stress echocardiogram or a nuclear or thallium stress test will be done. These stress tests are known as imaged stress tests because rather than just graphs that you would see on a stress ekg, the tests provide data and images which make it easier to pick up on subtle abnormalities.
Probably the key piece of information that comes from these tests is the left ventricular ejection fraction (LVEF). This is a measure of how efficiently blood is pumped out of the left ventricle and is considered a good measure of the overall strength of the heart, or put another way, how much damage the heart has suffered. In a normal healthy adult an ejection fraction would be between 65% and 70%. Anytime the LVEF is below 50% there is a very high likelihood that a life insurance application would be declined.
Bottom line. Successfully shopping for life insurance after serious health issues takes teamwork. You need a good, knowledgeable independent agent, but you also need to be willing to do your homework. Providing accurate information to life insurance underwriters during the informal trial or quoting phase will help to ensure no surprises with the final outcome.
June 9th, 2008
