Posts filed under 'breast cancer'
Not a week goes that I am not called by someone with a history of cancer. It can be as common and treatable as prostate cancer or breast cancer, or as unpredictable as multiple myeloma. They would like to have life insurance, just like anyone, but insurance quotes take more information and leg work than if your health issue was high cholesterol.
Unless a client has saved all of the reports and paperwork, it often means going back to doctors and asking for the information. But let me be real clear about this, there is no way that I, or any other agent or agency out there, can accurately quote life insurance with a history of cancer without the pathology. The only exception to that hard and fast rule would be a history of basal cell carcinoma, the most common and least deadly of all cancers.
So, when someone says they had breast cancer or prostate cancer, the next question coming from me is, “do you remember the stage and grade of the cancer?” Most of the time the answer is no. They might remember that it was an early stage or a low grade but those terms are about as generic and useless as they sound. Those are the things oncologists say because frankly they don’t want the patient burdened with details that they won’t understand.
Personally I think having that information allows a person to truly educate themselves on what they are facing and what their options are. Knowing the actual pathology opens the door to enlisting 2nd opinions. With all of the information available on the internet it also gives you the information needed to know if you would have other treatment options available.
From a life insurance underwriting standpoint, no matter what type of cancer you had, the earlier the stage and the lower the grade the better, but in order to shop it those have to be actual values and not just lower and better. An example might, simply stated, be a stage 1, grade 1 cancer. With breast cancer a stage 1 tumor measures less than 2cm/1in. Stage 0 would be an insitu, or fully encapsulated tumor. The lymph nodes in the armpit are not affected and there are no signs that the cancer has spread elsewhere in the body. A grade 1 breast cancer means that the cancer cells look very like the normal cells of the breast. They are usually slow growing and are less likely to spread.
Pathology is the key to the rating of the policy. It means, in most cases that clients will need to make a call or go by the oncologist’s office to get a copy of the pathology report. It’s not a big deal and shouldn’t require an appointment or cost anything. If you have paperwork from your cancer treatment stored, check and see if the pathology report is mixed in with that.
Find an independent agent, preferably one knowledgeable enough to know that you needed that report, and review the entire history from diagnosis through treatment to recovery and cure. Not all cancers are created equal, so stay open to what you will hear from the agent. It might be a good quote and it might be information on how long you will have to wait before you can get offers on life insurance.
Bottom line. Many types of cancer are insurable at very affordable rates within a short period after the end of treatment, so do the home work and Google your type of cancer and life insurance. Try to pick through and find truly independent agents who stand out as having a good understanding of how to get you from point A to approval.
March 12th, 2010
My wife and I are off to spend the weekend with my mom in Wyoming. For the first time this spring it appears there won’t be a major winter storm in between us. Happy Mothers Day!
It is my mom’s own fight with breast cancer that has renewed my optimism for the future of how life insurance underwriters view breast cancer. Her cancer was detected about a year ago, an early detection because even at age 84 she takes advantage of self exams, doctor exams and mammograms, the tools of early detection.
It is the key, early detection, to finding the cancer at a stage where it is still ultimately beatable. Even though her cancer had spread from the tumor in her right breast to some lymph nodes under her right arm, it was all surgically removed and after chemo and radiation, all of her checkups have been good. She is probably as optimistic at 85 as I have seen her in years.
For life insurance purposes, if she was in that market at all, she would still be waiting to be 1 year out from treatment, but given the pathology of her cancer she would likely receive very fair offers at that point. Our success in helping with women with a history of breast cancer has been an exciting combination of early detection, more pin pointed treatment and fairer underwriting all coming to bear at one time.
Bottom line. Don’t let that history of breast cancer keep you from applying through a knowledgeable independent agent. This is not the underwriting world of 10 years ago just as it isn’t the diagnosis and treatment world of 10 years ago.
May 8th, 2009
When I do an on the phone interview with a potential life insurance client I ask a series of medical questions that help me to decide the appropriate rate classification to quote. Part of the application process, whether it is done with your agent or with the examiner is called Part 2 of the application. This is where you get the opportunity to divulge your entire medical history.
I consider Banner Life’s Part 2 medical-history to be one of the more thorough. Some of the forms ask about medical history for the last 10 years and I think this misleads potential insureds into believing that medical history prior to that doesn’t matter. You may have survived breast cancer more than 10 years ago or recovered from a stroke more than 10 years ago, but those are still relevant events that will impact underwriting. Even if you answer no to something because it happened over 10 years ago, in all likelihood there is reference to that event in your medical records and it will come out anyway. Might as well lay the cards on the table.
That is why my phone and personal interviews always start with “Have you ever been diagnosed with or treated for?” and end with “Is there anything else in your medical records that we haven’t covered?”. You can see by the medical history form that very few stones are left unturned, but obviously every possible medical issue can’t be listed. That is another radar people will try to fly under thinking that if they don’t divulge it, the underwriter won’t know it. Trust me. You want them to know it up front.
Banner Life’s form has the most extensive family history question I’ve seen. Most companies only ask about heart disease, stroke, cancer and diabetes. I always get a chuckle out of their alcohol question, “Have you ever consumed alcoholic beverages?”
My best advice whether asked by an agent or an examiner, or left to answer these questions on an application on your own….be honest. Your life is chronicled in your medical records and even in information from other insurance applications. Independent agents are good at making lemonade out of lemons. Let them do it for you.
Bottom line. We all have a medical history, or at least all of us old folks. You might be able to slide one by an underwriter, but if your policy is approved in the absence of information known to you and withheld from the underwriter, it is contestable. Don’t do that to your family.
May 4th, 2009
It occurred to me after seeing a clip of Napoleon Dynamite on David Letterman that, given good health, even he could qualify for the best rates available for life insurance.
Fortunately for us all, being the best looking or the most successful isn’t found on a life insurance application. As many times as I have aired my feelings about the lack of common sense that underwriters seem to have cornered the market on, I can honestly say that I have not seen them swayed by an applicant’s position or influence.
That is not to say that it might not hurt if you were the cousin of the president of a life insurance company. I haven’t run into that personally, but it is true that there is a company tool out there that isn’t used as often as it was 3 or more years ago called a “business decision”. Before the changes that hit a few years ago with the consolidation of reinsurance companies, business decisions were fairly common. While they are at best rare today, there is no doubt in my mind that given the right incentive, they do still exist.
I recently worked on a breast cancer case that brought this reality home. After informal trials came back with decline after decline due to the stage and grade of the cancer, Lincoln National indicated that they would consider the case at a face amount of $250,000 or below, universal life, not term insurance, as a business decision. They ultimately declined to offer coverage as well. Still shopping that one and will until I get the job done.
Bottom line. Very few gifts floating around the life insurance sphere these days. The good news is that the playing field is level. The bad news is the playing field is level.
May 2nd, 2009
I’ve certainly questioned the IQ of more than one life insurance underwriter over the years. I may have even insinuated that a few didn’t even make into on to the IQ scale.
But the truth is there are two types of underwriters working on life insurance applications for us. The first, a group we try to avoid, have an underwriting manual in front of them at all times and if they are God fearing Christians, that manual is second in importance only to the Bible. The guidelines in their manual are followed faithfully and without question. If someone has bipolar disorder and the manual says to decline them, there is no room for looking at it from another direction or all directions, it is still a decline.
If two women had a localized breast cancer and one treated the cancer very aggressively, say with a double mastectomy, chemo and radiation, while the other decided that she would do the minimum acceptable treatment, the manual treats them exactly the same. There is no room for the fact that one method has a much higher survival rate than the other. It’s not broken down that way in the manual.
The second group of underwriters believe that the black and white manual provides guidelines and not rules and that since they are guidelines, there must be room to consider extenuating circumstances. These are the underwriters we seek out when we shop cases. These are the underwriters that give people hope that there is in fact intelligent life inside the walls of insurance companies.
It is this unique group that understands what to look for and what questions to ask in order to determine if someone with bipolar disorder is a poor risk, or as in the case of many, a completely acceptable risk. It is this group that understands that obesity in the absence of risk factors doesn’t present the same mortality risk as someone who is overweight and has coronary artery disease. It is this group that we look to for a sane review of a case involving sleep apnea, situational depression or family history. It is this group that sees beyond the health problem and factors in how a person is handling that problem, not inside the manual but in real life.
Bottom line. If you have an independent life insurance agent who has been around long enough to figure out underwriters to go to and underwriters to run from, you have found the path of least resistance and the path to success.
April 15th, 2009
Not a week goes by that I don’t talk to someone with a history of cancer. They would like to have life insurance, just like anyone, but insurance quotes take a bit more leg work.
It’s often a stretch and often means going back to doctors and asking for the information, but there is no way that I, or any other agent out there, can accurately quote life insurance with a history of cancer without the pathology. The only exception to that hard and fast rule would be a history of basal cell carcinoma, the most common and least deadly of all cancers.
So, when someone says they had breast cancer or prostate cancer, the next question coming from me is, “do you remember the stage and grade of the cancer?” 90% or more of the time the answer is no. They might remember that it was an early stage or a low grade but those terms are about as generic and useless as they sound. Those are the things oncologists say because frankly they don’t want the patient burdened with details that they won’t understand.
Personally I take exception to that thought process since having that information allows a person to truly educate themselves on what they are facing and what their options are. Knowing the actual stage and grade opens the door to enlisting 2nd opinions, or asking your physician about other treatment options.
From a life insurance underwriting standpoint, no matter what type of cancer you had, the earlier the stage and the lower the grade the better, but in order to shop it those have to be actual values and not just lower and better. An example might, simply stated, be a stage 1, grade 1 cancer. With breast cancer a stage 1 tumor measures less than 2cm/1in. The lymph nodes in the armpit are not affected and there are no signs that the cancer has spread elsewhere in the body. A grade 1 breast cancer means that the cancer cells look very like the normal cells of the breast. They are usually slow growing and are less likely to spread.
So, since the pathology is the key to the rating of the policy, it generally means that clients will need to make a call or go by the oncologist’s office to get a copy of the pathology report. It’s not a big deal and shouldn’t require an appointment or cost anything.
Armed with a pathology report, find an independent agent, preferably one sharp enough to know that you needed that report, and review the entire history from diagnosis through treatment to recovery and cure. Not all cancers are created equal, so stay open to what you will hear from the agent. It might be a good quote and it might be information on how long you will have to wait before you can get offers on life insurance.
Bottom line. From the time of diagnosis for your own education pathology is good to know. A more educated patient feels better about the process and a more educated life insurance client is more likely to get what they need.
April 2nd, 2009
I am 56 and I can tell you honestly that 3 years ago I had never read a blog, didn’t know what it was or what it was for. I just knew that for my business to grow, for us to reach more and more people blocked out of life insurance for the same old reasons by the same old companies, my website needed to be more than one of the millions just sitting out there.
Our focus at Hinerman Group has always been to seek out and help those that our industry has painted into what we call the impaired risk corner. If you’ve been there, whether because you have diabetes or bipolar disorder, you know there is something that just isn’t right about being told that a company “doesn’t want to accept your risk”. You know you’re not dying. You know, just because you have bipolar disorder or depression that you are not going to commit suicide. You know that your heart attack or your prostate cancer was a wake up call, not a death sentence. You know that breast cancer has changed your life, but won’t end it. Our goal has been and will always be to snatch you from the insurance jaws of defeat and find a path to victory.
To that end, the brilliant mind in Hinerman Group, my office manager/web master/head geek, has asked me to begin twittering. Well, slap me again, but I’m looking at twittering and not getting it. Now mind you I believe I understand blogging at this point and I believe it has reached hundreds, if not more, that we have been able to help, but twittering??
I thought I understood it when she (my head geek), suggested that I just post life insurance news and I guess I got that, especially at a time when there is no lack of day to day changes going on in the life insurance business. Especially at a time when we are finding victory after victory for our chosen group, the less than perfect folks like me out there.
So I did, and then I “followed” a few folks that I thought might have common interests and then some began “following” me, and I was back to square one. I didn’t get it. @JoyofDiabetes seems to have a lot to say and has quite a following, but he mostly seems to talk about his minute to minute life. Regular things like taking the kids to soccer or his wife being out of town. How do I blend in with that and just let people know I am available to talk about their problems getting life insurance without being booed out of the stadium for being a “salesman”.
Now, mind you I have never “sold” in my blog. I have suggested to people how to find the better rates and suggested how to avoid pitfalls and suggested how to avoid those agents and agencies and advisers that clueless, but in over 900 posts I have never said call me….buy from me….! So, twittering, or tweeting…….?
Bottom line. I trust the person that has brought me light years from where I started and if she says twitter, well, I will. My prayer is that it will help as many people as my blog has, if not more. So my twitter thing is @HinermanGroup. Let me know how I can be of assistance.
March 22nd, 2009
Breast cancer has been a source of ongoing discussion and some great victories over the past five years in life insurance. Earlier detection and advanced treatment has helped underwriters take a more aggressive stance and provide better offers than ever before.
Having said that, they still seem to have some hangups. A case I am currently shopping highlights one of those areas where they seem to be a bit hung up on the original diagnosis and have skipped over the reality of the prognosis. This particular client has inherited the BRCA1 gene, also known as the breast cancer 1, early onset gene. True to its’ billing she was diagnosed with breast cancer at age 40.
Pathologically speaking she was diagnosed with infiltrating ductal carcinoma and DCIS, ductal carcinoma in situ. By definition DCIS is actually a stage 0 cancer since, being encapsulated, it cannot and has not spread. Here’s where the problem begins in my attempts to reason with underwriters. In her pathology report the DCIS is shown as being stage 3. Impossible? I really don’t know but I’ve forwarded that information to a pathologist client of mine with Baylor Medical Center for a second opinion.
The second complication comes with the fact that, according to her first pathology report, the surgeon only took one sentinel node. A sentinel node is a lymph node taken from the underarm nearest to the location of the breast cancer. If the sentinel is positive, the cancer has spread. In her case the only node they biopsied was benign. I know from personal experience (my mother’s recent breast cancer) that taking one node is, well, odd. Based on my conversations with oncologists and the study I’ve done, generally there are anywhere from 10-25 nodes taken.
Two years later she was seen due to swelling in the lymph nodes in the same underarm and this time they biopsied 16 nodes and found two that were cancerous and pathologically cancerous with the same stage and grade as her original breast cancer. Safe to say that they missed two by only taking one? Don’t know, but most underwriters are trying to paint this as a new round of breast cancer rather than an error on the original surgeon’s part. Again I am searching for a second opinion. This part of my job gets sticky because doctors don’t like to say that other doctors didn’t do their job quite they way they maybe should have.
And the last piece to this puzzle is that the client, due to family history and the presence of the BRCA1 gene which also happens to carry some risk of ovarian cancer, has had a double radical mastectomy and a hysterectomy, theoretically not leaving anyplace for the gene to cause problems in the future.
Bottom line. We started this search with all of the underwriters saying absolutely no to life insurance. In round two of my searches we were able to get a few underwriters to say they would be willing to offer insurance 3 years out from the last treatment. I am now loading the cannons with my second opinions and heading into round 3.
March 19th, 2009
One of the great things from a life insurance standpoint in regards to early stage breast cancer, due to the very high survival rate, is that life insurance can often be purchased not too long after the cancer therapy is complete at as good as standard rates.
Probably the most common, and certainly the most treatable breast cancer is DCIS, ductal carcinoma in situ. In layman’s terms, an encapsulated, contained cancer in one of the milk ducts. Being in situ almost completely rules out any spread of the cancer and Tis along with T1 tumors are almost always good candidates for a lumpectomy procedure. This is often followed by a course of radiation and in some clinics a procedure called partial breast irradiation, PBI.
Even though these very early stage, very confined breast cancers can be survivable with minimally invasive procedures, many women choose, like actress Christina Applegate, a more radical approach, a radical double mastectomy. This course of action is an attempt to put any possibility of recurrence out of the picture. In the case of Applegate she felt the chance of recurrence was too high with a family history of breast cancer and testing positive the the BRCA1 gene that is linked to a higher occurrence of breast and ovarian cancer. It should be noted that even with the most aggressive treatment there is still a chance of recurrence.
The good news is that whichever route you choose, survivability with early stage cancer is good and life insurance pricing reflects that.
Bottom line. The keys to finding cancer in the early stages lie in taking the task seriously. Especially those women who come from a family with a history of breast cancer, a routine of self exams, doctor exams and regular mammograms is prudent.
February 27th, 2009
In reviewing my last post concerning some of the changes in underwriting of life insurance that occurred in 2008, I found some parallels between that and some of the most significant medical breakthroughs of the year. Could it be that underwriters are doing their homework?
From the discovery that BMI is not always a true indicator of the percentage of body fat and therefore not a good measure of diabetes risk, to the discovery that eating foods that contain “resistant starch” as a way to help fight obesity and bolster weight loss, medical researchers are, year by year, getting a better handle on how we can get a better handle on our health.
A clearer picture of treatment for type 2 diabetes came from one of the largest studies done so far. Critical in the findings is early detection through risk factor education. Discovered early and treated aggressively, type 2 diabetes doesn’t have to have to be the 800 pound gorilla in the room. Studies showed that combining treatment for diabetes with treatment for cholesterol, triglycerides and blood pressure gave better results than treating diabetes alone.
Breakthroughs in the detection and treatment of colon and breast cancer will likely prove to be a boost to 5 year survival rates. While not a guarantee of any immediate impact on life insurance underwriting, these are the types of things that help pick apart the “one size fits all” underwriting of the past. Simply put, it is becoming harder and harder to justify the same mortality assumption for someone who has done all the right things relating to early detection and proper treatment of cancer with someone who hasn’t.
Bottom line. Life insurance underwriting is constantly evolving and while the best rates out there will never be available for everyone, with the right independent agent using the right companies, a fair shake is a more likely outcome than ever.
December 29th, 2008
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