Posts filed under 'basal cell carcinoma'
Some years ago the life insurance underwriting world went into a tizzy because a study had come out insinuating that a person who had multiple basal cell carcinomas, a truly non lethal skin cancer, had a higher chance of having a melanoma, a truly lethal form of skin cancer.
This led most companies to treat multiple basal cell carcinomas more harshly than a single incidence. In most cases a single basal cell carcinoma would still be eligible for preferred plus rates as long as all other risk factors were good. With multiple cases (more than one) many companies changed their guideline rate to standard.
This stance has since softened and again most companies, even with multiple incidents, will still consider best rate class.
I worked on a case just recently where a client had a mole removed that “displayed dysplastic nevi”. Because the mole was benign we had expected the best rate class and were surprised when Savings Bank Life bumped the case one rate class due to a study that insinuated that a mole displaying dysplastic nevi could lead to a higher chance of melanoma. So, here we go again.
We shopped the case and found that the opinion is almost equally split on the subject. Many of the companies were still willing to consider their best rate class while some were going to offer no better than standard.
With a long history of working with clients with skin cancer I almost get the sense that insurance companies are trying to make more out of the possibilities than they need to. Even the two groups that I just mentioned, while some studies indicate a potential higher mortality, the truth is that unless they also live in Arizona, they may have a lower mortality risk than people who live in a sunshine laden place like the desert states.
Bottom line. It really comes down to my often espoused advice. If you have any kind of health history use an independent agent who can properly shop for you and make sure that you aren’t unnecessarily leaving one or two or three rate classes on the table.
January 15th, 2010
There is skin cancer, the most common cancer in the United States with over one million cases annually. Not to trivialize, but most of those cases are basal cell or squamous cell carcinoma and are generally easily and successfully treated.
It is the third in the trio of skin cancers that can and often does change and end lives, Melanoma. Melanoma, while a skin cancer, is extremely aggressive and invasive.
As with most kinds of cancer, early detection and treatment is the key to winning the battle. Self magazine recently ran an article on the ABC’s of Skin Cancer and gave a 5 step list for self examination and identifying problems while still in the early stages. The real message from this timely article was not to get caught sitting and watching a mole change or grow.
From a life insurance standpoint Melanoma is a tough challenge. The real issue is stage and grade, how advanced is it and how deep is it. A melanoma in situ is the best case scenario. Fully encapsulated with very shallow margins, a melanoma in situ can be removed surgically without concern of spread. Generally shortly after successful treatment standard or better rates are available. The deeper the Clark’s level of the melanoma the tougher the underwriting. With higher grade cancers it can be as long as 10 or more years before you can get back to standard rates and it is not unusual, just because of the tenacious, aggressive nature of melanoma, that once you have had it, you might never do better than standard rates.
Bottom line. Vigilance is the key. Don’t poopah that mole. Get it checked out by a dermatologist and if it starts changing at all, run, don’t walk back.
June 23rd, 2009
Very few weeks slip by that I don’t take the opportunity to drive home the life insurance consequences of not following through with a doctor’s recommendation for a test or a follow up visit. These may seem like small things, but in the world of underwriting it is seen as being non compliant and is a sure way to get declined, or at least postponed until you break down and follow directions.
That happened to be point number 4 in an article I read today with what I thought was an amusing title, “6 Health Mistakes Smart People Make“. In their example they talk about a woman not following up on a pap smear that showed suspicious looking cells. Doctors, and you would think patients, want to rule out any chance of cervical cancer, but too often the followup testing is not done.
Whether the excuse is too busy, too expensive, or that you don’t agree with it, not completing prudent followup is dangerous to you and a death blow to any attempts to get life insurance. Whether it is going on cholesterol meds and not following up to see how it’s working or what impact the medication is having on liver functions, or someone who has had a basal cell carcinoma removed and doesn’t regularly see a dermatologist, not following through with medical advice can be a mortality risk you’ll wish you hadn’t taken.
Bottom line. All six suggestions are good, but I thought a bit strange that they would make it sound like smart people are supposed to somehow care more about their health. The truth is that doing all the right things when it comes to our well being is just not that common no matter the IQ. People don’t want to admit they have health issues and they don’t want to have to submit to a routine of checking up on themselves.
May 12th, 2009
Compliance and control! I haven’t beat that drum in a while, but that doesn’t change the fact that those two issues are the major underwriting issues in almost all life insurance applications where health is less than perfect.
I have used that soapbox most often pertaining to diabetes and the fact that without the two C’s, you are not going to like the rates you are approved at (best case) or the fact that you get a decline (worst case). But compliance and control weigh heavily on most health issues from high blood pressure to bipolar disorder.
Compliance could be defined as doing what it takes to stay on top of the health issue. If you have diabetes, for instance, compliance might mean that you check your glucose regularly and that you take your medication exactly as it is prescribed. There is a real tendency for people to get lax with these things and check glucose or take medications when they are having those low glucose kind of feelings. There is also a tendency to be lax about the quarterly followup visits that most doctors want to see. Having full labs done every three months is exactly the way to stay on top of your diabetes and away from all the collateral health issues that could pop up.
So, the same things that are going to positively impact your health are what the underwriters are really looking for. If obesity is an issue, a doctor monitored diet and exercise program. If sleep apnea is an issue, consistent use of a cpap machine. If skin cancer such as basal cell carcinoma is an issue, regular visits to a dermatologist is prudent and reasonable.
Bottom line. Doing the right thing pays dividends. Ignoring them carries a penalty.
April 24th, 2009
I’m often asked, after the fact, what it takes to get the best life insurance rates. While I would be hard pressed to cover everything that could be hiding in your medical records, I can provide a general rundown based on the exam, labs, family and personal history.
Generally a person can’t have used any kind of tobacco or nicotine products in the last 5 years. They test for it and while the test really won’t show anything more than a month or two old, medical records almost always indicate if a person is smoking or uses other types of tobacco. If you say no and die during the incontestability period due to lung cancer, you better figure they will be asking people who were around you prior to your death.
Family history generally holds the best rate at “No cardiovascular disease or cancer prior to age 60″ for your mother, father and full siblings. A few companies say no death prior to age 70 and a few add diabetes to the before age 60 list.
A few companies allow blood pressure treatment for their best rate. Most don’t allow it. Either way, good control is a must with 135/80 being a pretty standard benchmark. Some allow 140/80. That’s actually pretty liberal. Most healthy folks are more in the 120/75 and under range.
Cholesterol treatment is being accepted for the best rate class by more companies all the time. That being said, good control is being looked at more stringently than ever before. The old benchmark for most companies was a total cholesterol of 220 and HDL of at least 40 giving a ratio of 5 or less. Some companies are going as low as 205 and a ratio of 4.5 for their best rate now.
The only cancer history acceptable at the best rate class is one instance of basal cell carcinoma. Multiple basal cells can be OK with some companies, but any other cancer history will end your chances for the best rate class.
Your driving record counts. Most companies won’t allow more than one moving violation in the last 3 years and yes, they will pull an MVR and check. Best case for the best rate would also include no reckless driving, DUI’s, license suspension or revocation in the last 5 years. Many companies are more stringent on the DUI topic.
Private pilots can only get the best rate from a few companies and they generally have to be well qualified. Instrument rating and enough total hours and annual hours to be considered experienced is a must.
Hazardous activities is kind of a crap shoot. Scuba diving can be ok if you aren’t going below 100′. Skydiving never gets the best class. Rock or mountain climbing, car or motorcycle racing and extreme sports will almost always bump you out of running for the best rates.
The last of the general underwriting guidelines is build. All companies have height/weight charts that they use and for the most part they run pretty much the same. Using my height of 5′10″, a sample of weights for best class are American General at 195, Banner at 196, Genworth at 193 and probably the most generous is Prudential at 202.
Bottom line. They don’t just ask how you’re feeling and give you a policy at the best rate. There are a lot of people who say these rates simply aren’t attainable, especially at older ages, but plenty of my clients receive offers in the best rate class and the oldest of those was 79 at the time.
February 17th, 2009
Considering the turmoil of the economic meltdown that was 2008, it’s always good to find and hold onto bright spots. Here is just a quick review of a few of those bright spots coming from a most unlikely source, life insurance underwriters.
For years there has only been one company that would allow their best rate class for well controlled, treated high blood pressure. For those of us who deal with this issue and watch companies inflict a 30 percent hit on those who are often treating borderline blood pressure issues, to now have two companies that will allow treatment coupled with good control is a home run.
Another health concern that took a turn back toward sanity this year was the issue of basal cell carcinoma and specifically the underwriting treatment of someone who has had multiple cases. A few years back there was a study that showed there might be a link between those with multiple basal cell cases and the potential for melanoma, the deadly skin cancer cousin. At the time most companies changed their underwriting of multiple basal cell cases to best case standard rates, about 100% higher than their former stance that basal cell was not a rateable issue. This year many companies reversed course on that decision and have once again decided that basal cell, whether a single incidence or multiple, shouldn’t impact a person’s rate.
Diabetes made some headway this year. Without going into all the detail it needs, suffice it to say that there has been some loosening of the standard guidelines for earlier onset type 2 diabetes and some significant changes to the guidelines for type 1 diabetes. All of these changes have one thing in common and that is the assumption of good control.
Anyone who has followed my rantings about life insurance know that this has been a year of significant gains in underwriting of bipolar disorder. Hinerman Group has successfully placed more cases this year than any previous year and all indications are that the trend will continue. Again, there shouldn’t be any assumption that life insurance is a guaranteed thing with bipolar, but given good compliance, good control, and a level or work and social stability, good rates are achieveable.
Bottom line. The headway made in 2008 is a trend that we expect to see continue. Some of it is attributable to changes in insurance company change in philosophy. Much of it is attributable to the growth and change we’ve achieved on our end. We are doing a better job of understanding what will move an underwriting decision and also in forging new underwriting relationships and solidifying those who we have counted on for years.
December 26th, 2008
Skin cancer is the most common cancer among both men and women in the US. Life insurance underwriters have shown a lot of movement on their underwriting guidelines for skin cancer over the past several years. Unfortunately, until recently, it didn’t seem to be in any clear direction.
Probably the best news has been in the risk evaluation of low stage melanoma. Melanoma is the least common skin cancer but accounts for 75% of skin cancer deaths. But, what we’ve seen recently especially in stage 1 and 2 melanoma , is a tendency to get back to standard rates quicker after surgical removal of the cancer. While higher stages may incur a flat extra for a longer period, lower stages can generally be seen within a year with no recurrence.
The other significant shift in skin cancer underwriting has come in basal cell carcinoma and squamous cell carcinoma. In the past these two generally flew under the underwriting radar because of the relatively low mortality risk. A few years ago a study indicated people with multiple basal cell carcinomas were at increased risk of acquiring melanoma. This led to an underwriting swing away from ignoring basal cell to offering no better than standard for people with multiple instances. This stance has also softened somewhat with further studies showing the connection to be more vague than first thought.
Bottom line. Once again, this is not an area where your car insurance agent is going to shine, and I wouldn’t depend on large internet agencies to really dig in deep and get the job done as it should be. A knowledgeable independent agent should be able to ferret out the best opportunities for low rates with your particular history of skin cancer.
July 29th, 2008
In my experience it is the guys in this world that not the brightest lights on the block when it comes to preventive measures like using sunscreen, wearing hats and not overexposing themselves to the sun. I would put my money on men to be the first sex to be overwhelmed and become extinct due to skin cancer.
Growing up on a golf course or at the lake, I know that sunburns were worn and compared like badges of honor. Losing multiple layers of skin over the course of a summer was a job well done.
Now an alarming study shows that men, for all of their brainless effort for the last 30-40 years, are being left behind when it comes to increases in the number of new melanoma cases. Since 1980 diagnosis rates in younger (15-39 year old) men have remained level while the number of younger women diagnosed has risen 50%. Melanoma is the most dangerous of the three types of skin cancer.
This is especially foreboding since most skin cancer is diagnosed at older ages. There were a couple of factors noted that may have contributed to this disparity in the rise of melanoma cases. First, woman are more likely to wear sunscreen and because of that, may expose themselves to more sun because they feel protected. The other culprit could very well be tanning beds. Not a lot of guys hang out in the UV sandwich looking things.
From a life insurance standpoint melanoma is a serious subject, and for good reason. Unlike its’ less potent cousins basal cell carcinoma and squamous cell carcinoma, melanoma kills. Depending on the stage, grade and depth, it could easily be three to five years after treatment before reasonable rates are available and melanoma is one of those health issues that may very well prevent you from ever getting better than standard rates again.
Bottom line. It remains to be seen what these statistics in “younger women” foretell 20 years down the road. Time to rethink our rethinking of our relationship with the sun.
July 11th, 2008
The word cancer used in reference to anything to do with life insurance usually conjures up visions of declines and huge rates. In that regard skin cancer is something of a different animal.
Skin cancer is the most common cancer in both men and women, mostly thanks to the fact that most of us had no idea that sun could be harmful 30 and 40 years ago as we religiously broiled ourselves at Memorial Day lake parties. There are three types of skin cancer.
Basal cell carcinoma, sometimes called non-melanoma skin cancer is the most common. It is most frequently seen in light complected people. Basal cell has about a 95% cure rate, so it isn’t the most feared cancer by any stretch, but recent surveys have shown that multiple basal cell instances put a person at higher risk of more dangerous skin cancer. This fact has not been lost on life insurance underwriters who, as recent as five years ago, didn’t rate basal cell at all, not even multiple instances. Now, while most companies will let a single instance slide, multiple instances may bump a person to standard rates.
Squamous cell carcinoma is almost identical to basal cell except in one aspect. Basal cell, in the 5% of cases where it becomes a problem, generally goes deeper into the skin and can sometimes reach the bone, but it doesn’t spread to other areas of the body. With squamous cell, the cure rate is essentially the same, about 95%. The issue with the other 5% in this case is that squamous cell can spread to other parts of the body. Underwriting on squamous cell will depend on the stage and grade and if it has spread. If it is a low stage and grade with no spread, often preferred rates can be done if there is a single instance. Multiple instances would be standard rates best case.
Melanoma is the last of the skin cancers and although it represents only a few percent of the total skin cancer occurrences, it is responsible for 75% of the deaths. Underwriting melanoma is a whole different ballgame. With a low stage and grade melanoma, the best case would be a rated policy (higher than standard) when you’ve reached one year post treatment. That is best case. Remember, with cancer it is all about stage and grade. I’ve seen melanoma history get no better than standard 10 or more years after treatment.
Bottom line. Skin cancer is not an issue that you want to tackle without an independent agent. Most life insurance companies will be more cautious than I have described.
May 28th, 2008
Guys! The boogie man isn’t under the bed, but rather right below our belly buttons, just about a finger’s length up our rear ends. I’m talking about the prostate gland and the fact that 1 in 6 men will get prostate cancer in their life time.
Prostate cancer is the second most common cancer right behind the skin cancer trio of basal cell carcinoma, squamous cell carcinoma and melanoma. While a statistically huge number of us will be diagnosed with prostate cancer, the good news is that the survival rate is very good, with only about 1 in 8 who are diagnosed actually dying from the cancer.
It is this survival rate, driven by early detection and effective treatment options, that makes prostate cancer one of the easiest for life insurance underwriting. The earlier the cancer is detected, the lower the stage and grade and the better the treatment results. With more and more men getting regular PSA tests, expect that survival rate to climb in the future. By the way, my most recent health fair results showed my PSA at .9, down from 1.1 two years earlier. Safe for now.
I’ve review a lot of articles about prostate cancer and how to avoid it. This one I read just recently is kind of like just doing what your mother said. Eat your vegetables! Sure can’t hurt and it tastes good too.
Now, back to the subject at hand. As a baseline underwriting view, if your cancer is diagnosed when the PSA is 10 or less and the biopsy shows a stage of T1 or T2 with a Gleason grade of 3+3=6 or better, depending on treatment results you could be back from the brink of uninsurable to close to standard rates in a year. That scenario would be if treatment was a radical prostatectomy and your PSA was at 0 for a year. With other treatment options the time frames can change.
Bottom line. Good news. Ultimately very survivable and very insurable. Talk to an independent life insurance agent about it today. Make sure you have a copy of your biopsy and that you know all of the relevant test results. The more information you can provide, the better the chance of finding good rates.
May 23rd, 2008
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