Posts filed under 'bypass surgery'
No, I’m not getting into pet insurance, but I would like to talk about the lack of curiosity people have about their own health.
From the simplest of things Americans start out with failing grades, possibly because it’s not taught in schools or possibly because we choose to follow our parent’s examples. How about this question? When was your last annual checkup? It’s a trick question, so take your time. Remember that your last annual checkup means there had to be one the year before.
Unless you’re in the military I doubt if there are many out there below age 50 that had a last annual checkup, if they’ve ever had a checkup at all. So how about a full physical including lab work? I know you feel fine but people can feel fine and have a boat load of cholesterol or triglycerides. You can feel fine in the early stages of diabetes. Heck, I know people that felt fine right before they had a heart attack. And I know it costs money, but finding something out early costs a lot less than finding out a little on the late side.
I talked to a client of mine the other day who had a 3 vessel bypass surgery about 5 years ago. He wanted to look at replacing a term insurance policy that is coming down to the last couple of years of guaranteed premiums. I asked when his last cardiac workup was, specifically when the last time he had a stress test would have been. He said he was pretty sure that there had been anything but run of the mill ekg’s since they had done that procedure. I explained that from a life insurance underwriting standpoint a stress test provided a wealth of information, probably the most important being how that tune up was holding up and how his heart was working. More substantive and meaningful information comes from say, a stress echocardiogram versus and resting ekg.
He said he had never really given followup any thought. He figured it was fixed and that was good enough for him. It just so happened that the day after I talked to him former President Clinton had to have a procedure to put a stent in a clogged artery several years after he had had bypass surgery by the arguably the best doctors in the country.
Bottom line. Life insurance underwriters are curious. They want to know how things have held up, or changed since that bypass. They want to know that, even though your cholesterol is better than it was, no new arteries are clogging. They want to know how your heart works under stress. They like to know that you are curious enough to have that stuff checked out.
February 15th, 2010
There was a time when I had a whole different view of obesity and gastric bypass. I think the majority of folks still look at the whole thing through somewhat jaded and certainly uneducated eyes.
I will just be right up front and ask to be forgiven for the way I felt about the issue. I truly had no idea back then just how hard it can be to break the cycle of obesity and I truly had no idea just how at risk of premature death someone could be if they were extremely overweight. I just thought of it as a control problem and a gastric bypass as an easy way out.
After years of study I have a much different view of obesity and just how difficult it is to make meaningful changes in your weight and I also had a much greater appreciation for just how much danger a person was in the longer the weight stayed on. The risk of high blood pressure and stroke, diabetes and heart disease are not things that can be taken lightly and certainly aren’t health issues that, if a person has a way of stopping them, should be put off or ignored.
The studied truth is that for those whose health is at risk due to obesity, gastric bypass is starting to not just be seen as measure of last resort, but as a prudent medical decision. Studies have shown that most people being treated for hypertension or type 2 diabetes can be off of medication completely within just a few weeks of having the surgery. In the truest sense the bypass surgery isn’t just a treatment, but a cure.
From a life insurance standpoint, gastric bypass is viewed cautiously until the weight loss has stabilized. This usually takes about a year. It’s during this year that complications can still crop up. Then, most of the companies that are good with obesity issues will want to see a year of stability before they will approve at standard or better rates.
Bottom line. Gastric bypass surgery is not just an obesity easy button. It’s a measured decision that can help save a person’s life.
May 11th, 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
Let’s don’t mince words on this subject. If someone is 40% overweight they are twice as likely to die prematurely than someone of average build. It’s not the fat that kills you, but the strain that all that extra weight puts on your body making you a prime target for obesity caused health risks.
The point I want to drive home and the key to reasonable life insurance rates for the overweight is to consider the insurance before any other health issues show up. Weight by itself can increase your life insurance rates, but not to the extent that weight plus diabetes or weight plus heart disease or weight plus cancer will.
A good example of this is a client just recently, who at 6′3″ and 325#, was able to get a standard rate through Prudential because all of the risk factors were excellent. He had blood pressure and cholesterol numbers that anyone would love to stuff in their medical records. His glucose was 87 on the exam. We talked at length and he recognized that he had a need for life insurance and that there was simply not a better time. He knew that because of his weight, his long term health could be an issue.
I was recently contacted by a man who had undergone gastric bypass surgery several years ago and had been told that, because of that surgery, he was uninsurable. Gastric bypass carries less of a stigma than it used to. It used to be looked at as kind of a lazy man’s diet, and a dangerous one at that. But more recent studies have shown that the reward of the drastic action may in fact trump the risks of whittling away at weight a few pounds at a time. The person who contacted me ultimately got a standard plus offer from Banner Life insurance, a classic case of having contacted the wrong agent who applied with the wrong insurance company the first time around.
Bottom line. It won’t cost you anything to find out what life insurance would cost you right now, but the cost of waiting could be the addition of health complications.
April 9th, 2009
I recently had a person email to tell me they had been declined for life insurance because they had a successful gastric bypass surgery three years ago. They wondered if, since this had come at the hands of a reputable company, they were just saddled with the fact that they were uninsurable no matter what.
They were uninsurable when morbid obesity would have been a kind way to describe their situation and among other health issues they were also dealing with type 2 diabetes. Now, three years later their weight is stable and very respectable and they are no longer diabetic and they are being told that they are still uninsurable. What gives?
Gastric bypass has been on an underwriting roller coaster for the past several years. At first companies were accepting the new weight of an individual one year after the weight had stabilized. So, if you lost 100 pounds in six months and leveled off, at 18 months out from surgery you could get insurance that was based on your new weight. Then some companies jumped clear off the deep end and wouldn’t consider someone until 5 years post bypass. Most recently the trend has been toward two years post bypass and at least one year of stabilized weight.
The problem from a consumer perspective is that there are companies that have stepped off the ride at different points and because of that, without the guidance of an informed independent agent, a person can inadvertently, innocently pick the wrong company and get mowed over like the gentleman I described above.
The good news is that there is good news for those who have chosen to undergo a gastric bypass procedure in order to get their lives back under control. Life insurance companies recognize that the procedure has risk, but many of them also recognize that there is great reward and a new life once the risk has passed.
Bottom line. Gastric bypass has survived the stigma of being the easy way out and is now recognized as a life changing and life saving decision. With life insurance the key is finding a company that supports that idea.
March 30th, 2009
It’s been a fascinating couple of years. I will sum it up by saying that we have helped a lot of people get life insurance who never thought they could. And what better way to celebrate the information we’ve shared and the victories we’ve had than with a shared meal, a key word salad.
Diabetes has been at the forefront of our life insurance efforts from the very start. We’ve made huge headway in finding aggressive underwriting for type 1 diabetes and type 2 diabetes. I think our strong point has been in education. There are a lot more people out there today that know what their A1c is than when we started.
I’ve been very clear about where some of the problems lie in our industry. The AARP/New York Life collaboration, on what can only be described as a sick crime against older folks, continue to offer the worst term insurance and whole life insurance in the business. They are simply not the advocate they claim to be.
I’ve stepped on some toes along the way. Selectquote and Zander Life insurance have taken exception to some of my observations. Being a Dave Ramsey fan and I think, ultimately, a reasonable person, I did apologize to Zander. In spite of Selectquote’s berating commentary, I still stand by my assertion that they are biased in what companies they offer (otherwise they wouldn’t be so easy to beat) and I still believe that Suze Orman should go back to waitressing. As to their assertion that I only use Selectquote and Suze Orman for search engine optimization, well, I don’t, even though they think I do. If I didn’t think there was better service elsewhere and more honest advertising, I would never have mentioned Selectquote.
We’ve touched on scuba diving and Prudential being a leader in great rates for recreational divers. Pru also stomps the competition on prostate cancer, sleep apnea and mild anxiety issues. While providing direction on those issues we have also been able to provide direction for those involved in skydiving and foreign travel to places where kidnap and ransom insurance is more than just a casual thought.
We’ve stayed abreast of the economic meltdown and recession that have whacked us all and tried to help people understand how best to handle their life insurance needs in these tight times.
We’ve held lengthy discussions about obesity and the impact it can have on other health issues such as hypertension or high blood pressure, cholesterol, heart disease, heart attack, stroke and cancer. We’ve discussed the risk and benefits of gastric bypass surgery as a means to avoid the life threatening side effects of being over weight.
Probably our biggest response has been from those suffering from depression and bipolar disorder. We reached a group of people that have truly been black balled in the insurance industry and we’ve been able to find some level headed underwriting and hit some major home runs for those who have the name tag but lead normal lives.
We have bared the facts behind the black eye of all black eyes in the insurance industry, the non guaranteed whole life, universal life and variable universal life policies and explained the alternatives in the permanent insurance market. There is nothing that provides greater value and peace of mind than a rock solid guarantee.
We’ve had frank discussions about business life insurance such as key man insurance and buy/sell life insurance. We did a whole series on women and life insurance. We’ve provided direction and information to private pilots that they aren’t getting anywhere else. We’ve talked about the guts of the policy when it comes to the two year suicide and incontestability clause and the accelerated death benefit and the beneficiary rights and the beneficiary issues for those who aren’t in a legal relationship such as a gay couple or an unmarried couple.
Bottom line. And the list goes on and on. We’ve tried to leave no stone unturned and no question unanswered in our quest to find life insurance for those whose mortality risk might be more challenging than average. As an independent agent it has been gratifying to have so many ways to help those who have been mishandled by the wrong agent or the wrong company. As we continue to reach out my prayer is that all who need help find it, and that more agents consider serving those who are harder to help.
March 18th, 2009
Just 10 days into the year. 1/36th of the way through it. We hardly even have our feet wet in the new year yet and I have been bowled over by as much acute denial in this short period than I am in an average month. Is it possible the economic meltdown is causing mental meltdown too?
The biggest source of the denial has been people who have cardiac histories and are still smoking. I’ve talked about the life insurance underwriting take on this bit of human health ignorance before. Smoking is the single largest factor causing heart disease. What kind of a pin brain would continue to smoke after they know they have heart disease?
One says, “Well, I’m an airline pilot so I’m in better health than the average person because I get annual physicals.” Excuse me? I always thought you must have to be pretty smart to keep one of those things in the air but I guess not. You can have 12 physicals a year and if you have coronary artery disease and still smoke you aren’t healthier than any average person on the planet. You just get more physicals.
Another said, “Well, but that heart attack was 10 years ago and I’ve been doing fine since.” Smoking is the leading cause of heart disease and heart attacks. Your body has already screamed about the abuse, so cut it some slack and quit smoking.
And then there was the lady who had a 4 vessel bypass surgery 8 years ago and hasn’t been back to a cardiologist since and doesn’t understand why a life insurance underwriter would be nervous about the risk. I asked her how they originally discovered she had 4 blocked vessels and, well, it was because she had a physical with an abnormal stress test. She didn’t see the correlation between that life saving stress test and having an occasional followup stress test. She claimed that her cardiologist told her there wasn’t any reason to come back after the procedure. She decided I didn’t need to know the name of that doctor as I wanted to call and see if that was what he really said.
Bottom line. I have decided to make 2009 a year of good news about life insurance. We hit home runs for people every day in this business and inspite of this streak of cardio-denial, we will continue to come through not only for those who take health seriously, but for those that don’t. It will just cost a bit more for those that don’t.
January 10th, 2009
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
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
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