Posts filed under 'bypass surgery'
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
There is a real tendency in our society to brand the morbidly obese as taking the easy way out of the problem they’ve created by considering gastric bypass surgery.
Gastric bypass reduces the size of the stomach by stapling off the majority. This causes massive weight loss due to the inability to take in enough food to amount to significant calories and simply curbing appetite. Saying that gastric bypass is the easy way out is a bit like saying heart bypass surgery is the easy way out of having a heart attack.
The truth is that chronic morbid obesity can lead to diabetes, cancer and heart disease. Studies have shown that diabetes can actually be cured by the forced weight loss that comes with gastric bypass. And as much as those of us who have never been obese would like to think it’s no big deal to drop 100+ pounds, get a grip. It is a big deal and it is not easy. Dropping large amounts of weight and keeping it off is a mental and physical battle. Just like being a life insurance agent, if it was easy everyone would be doing it.
From a life insurance perspective gastric bypass is a good thing….after some time. The rule of thumb with the best of companies will be a year to two years after weight loss stabilizes. It can take one to two years to reach that point, so post gastric bypass it can take three to four years before companies will consider you at rates commensurate with your actual weight. Why the caution? There can be post surgical complications such as infection or intestinal leakage. Weight loss can be reversed in some cases where the new, smaller stomach stretches. Underwriters want to know that everything has worked out and generally, given those timetables, they can be pretty confident that the issue is gone.
Bottom line. Any stigma that gastric bypass has should be stuffed away. It is a life saving procedure, not an easy way out.
June 23rd, 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
