Posts filed under 'coronary artery disease (CAD)'
Angioplasty has been praised for its’ less invasive approach to fixing clogged arteries than the traditional bypass surgery by many and it has been labeled a dangerous scam by others.
In light of a couple of takes on angioplasty by CBS news this week I want to throw out some discussion about the subject from a life insurance standpoint and from a medical point of view.
Angioplasty has kind of devolved over the past ten years in the eyes of life insurance underwriters. At first seen as “the new and better way” to address clogged arteries, angioplasty received more favorable underwriting than the other surgical alternative, open heart bypass surgery. With, for instance, a 3 vessel angioplasty versus a 3 vessel bypass, in the absence of a heart attack, the angioplasty would have had about a two table edge in the past.
Today there is virtually no difference in the underwriting outcome between the two procedures. Mortality experience post procedure is almost identical and underwriters who once thought the angioplasty would have a better experience because it was less invasive now have enough data to dispel with that notion.
Then there’s the issue of overuse of angioplasty, whether you believe that’s because it’s so easy or it’s so easy and lucrative. The truth is that a doctor may be inclined to be too aggressive in using angioplasty because of its’ ease when the blockage could, in at least 30% or more of cases, be controlled and reversed medically. From an underwriting point of view there is a huge difference between someone diagnosed with coronary artery disease who is treated successfully with medicine and someone with an identical situation that undergoes angioplasty or bypass surgery. Whether right or wrong there is a perception that if surgical intervention of any type is warranted, the CAD must be more advanced.
Doctors often tout angioplasty as the safe way to address arterial blockage. The problem lies in the fact that the procedure is often done in non emergency situations where there is no real need for easy or fast. And it is often done in hospitals that don’t have a cardiology unit backup so if something does go wrong the option of open heart surgery is still available.
So, medically speaking, the question is drugs versus angioplasty? A 2007 study showed that in non emergency situations (no heart attack happening), there was virtually no statistical difference between the choice to have an angioplasty or take clot busting drugs.
Bottom line. From a medical point of view, in non emergency situations it certainly seems prudent for doctors to ease the panic of the situation and discuss the alternatives. Please understand that I would never suggest that someone dictate medical choices based on how it might affect future life insurance premiums. What I am saying is that it appears there is ample evidence of the overuse of angioplasty and that overuse is affecting patients far beyond the medical issue.
June 11th, 2009
With most life insurance agents and most life insurance company underwriters, the mere mention of a history of seizure disorders or epilepsy is enough to bring the conversation and the application to a screaming halt. Not unlike a lot of the less common health issues, the agents don’t know what to ask and the underwriters don’t truly know how to assess the mortality risk or lack thereof.
A brief overview from the Epilepsy Foundation website tells us “Epilepsy is generally not the kind of condition that gets worse with time. Most adults who have it can expect to live a normal life span.” A normal life span? Isn’t that what life insurance underwriters are looking for? Lack of mortality risk? The answer is yes. Absent other health issues, if most adults who have epilepsy or other common seizure disorders can expect to live a normal life span, an expectation of paying no worse than standard rates is reasonable.
“Doctors treat epilepsy primarily with seizure-preventing medicines. Although seizure medications are not a cure, they control seizures in the majority of people with epilepsy.” I keep harping on what underwriters want to see when a person has a serious medical condition. It’s the same with diabetes, coronary artery disease or cholesterol. CONTROL AND COMPLIANCE!!! If you have epilepsy and are compliant with doctors orders, then you should have control. Good life insurance rates should follow control and compliance.
You need a good independent life insurance agent who doesn’t flinch when you mention epilepsy, but rather asks more questions like, “What medication you take? When were you diagnosed? How frequent are your seizures and when was you most recent seizure?, etc” If they head down that road with you, you are in the right office or on the phone with the right agent. If they don’t ask questions or don’t seem to have some working knowledge of your condition, keep on looking.
Bottom line. For most people with well controlled seizure disorders affordable life insurance rates are well within the realm of possibility. If that hasn’t been your experience consider the possibility that you may have put your trust in the wrong agent who led you to the wrong company.
May 13th, 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
There are probably more than five tips for type 1 and type 2 diabetics who are looking for life insurance and don’t want to pay through the nose for it, but let’s take a quick look at the most important.
1. Educate yourself about your diabetes. Understand and be able to explain to an independent agent when you were diagnosed, exactly what your treatment is, how long you have been on your current treatment, what the trend in your hbA1c levels has been, and if there have been any collateral health issues. For type 1 diabetes collateral health issues might be kidney or eyesight problems. For type 2 diabetes, neuropathy, heart disease or hypertension are often associated problems.
2. Get copies of your lab results and make it your job to understand them. If you are taking care of yourself, then you not only check your glucose frequently, but you also get at least quarterly lab work and a consultation with your doctor. Your labs will have a lot of valuable information on it. Ask your doctor what the results mean. Ask if they are good or bad. If your doctor isn’t very clear and supportive of your self education, find a new doctor. Keep a copy for yourself each time you go so you have your own record. Ask about and remember what your A1C level is each time you go. Also keep a record of your blood pressure readings. Your doctor will take them every time you are there. If you already have hypertension, monitor your blood pressure at home as well.
3. Understand control and what it means for your life (and life insurance). With good control of your diabetes, which for life insurance companies is an A1c of 6.5 or less, you can expect that diabetes won’t affect a long healthy life. If you don’t stay on top of your treatment and don’t avoid the temptation to be slack about your lifestyle, you can end up with coronary artery disease, retinopathy, and a host of other life changing and life ending problems.
4. If you are diabetic and are taking care of yourself, never, NEVER, let a life insurance agent tell you that you are uninsurable. A good independent agent will be able to find what you need at a reasonable rate as long as you have done your part and taken your diabetes seriously.
5. Seek out life insurance agencies that really do understand diabetes and life insurance and don’t just use the key words to entice you.
Bottom line. Getting good life insurance rates when you have health challenges is a team effort. A good independent agent can find the rates as long as you do your part.
March 10th, 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
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
For just about any health issue there is a “sweet spot” for life insurance underwriting, that place where all of the pluses overcome the minuses and a better than usual approval is received. This is especially true of underwriting guidelines for type 2 diabetes and the good news is that with current treatment options it is possible to shoot for and reach the thresholds that bring lower insurance prices.
With diabetes underwriters are looking for those people who accept that they have it but aren’t willing to let it get a hold on their medical future. A lax attitude toward diabetes can lead to complications and collateral health issues, none of which paint a pretty picture for the years to come.
To start with, early onset type 2 diabetes is a problem. Most type 2 can be traced back to life style issues with obesity being the number one culprit. If a person, due to poor life style choices, has diabetes starting in their 20’s-40’s, convincing an underwriter that you present a good life insurance risk is going to be very hard. The first sweet spot in underwriting type 2 diabetes is onset after age 50 and not linked to morbid obesity.
The underwriters want to see compliance with your doctor. Do you take seriously your doctor’s recommendations to lose weight, exercise and change diet? Do you take your medications and check your glucose regularly? Have you done any diabetes education classes? Do you know what an hbA1c is and do you know what your’s is?
Underwriters want to see control. They don’t care if you can fast and get a glucose reading of 98. They want to see that you hbA1c is less than 6.5 which would indicate that your glucose levels have been consistently in a controlled range for the past three months.
And last, but by no means least, to get the best rates you can’t have other risk factors such as eye sight, high blood pressure, kidney problems or coronary artery disease (CAD).
Bottom line. The sweet spot for diabetes underwriting is all about late onset and good compliance, education and control.
June 16th, 2008
When you apply for life insurance it is not a given that you will get what you want or what you believe you deserve. By far the majority of policies are approved with no surprises. A smaller percentage are approved but at a different rate. And a small percentage are declined by the insurance company because they perceive the risk to be unacceptable.
So why do declines happen? What are the most common reasons that a perfectly good application can result in complete rejection? What impact does a decline have on your ability to get insurance through another company?
The most common reasons are:
1. Something comes up on the lab results that neither you or the agent knew about. It has not been an uncommon occurrence for clients to find out, due to the life insurance exam, that they have prostate cancer, hepatitis, diabetes or the beginning stages of coronary artery disease (CAD). I know I blog all the time about how you can get life insurance with these conditions, but that assumes that you know about it, are treating or have treated it, and it is cured or under control. This reason for decline happens most frequently with people who don’t see the value of an occasional physical.
2. Non compliance with your doctor. For those who do visit the doctor occasionally, there is often a recommendation to have something looked into further or perhaps a recommendation to come back for a follow up in 6 months. Sometimes the doctor will give you a referral for say, a stress test or additional lab work. Plenty of folks blow those things off because they feel fine and can’t see wasting the money. Life insurance underwriters have a zero tolerance for people who don’t do what is recommended by the doctor (that they went to for a checkup and advice).
3. Stupidity. I had a client who had colon cancer about 13 years before he came to me. They removed part of his colon, did chemo and radiation, and he had not been back to a doctor since. It really kind of takes gall to even apply for life insurance with that attitude. Why would a company insure you when you don’t even care if you live?
4. Assuming that some past medical history doesn’t matter. Even though I start my relationship with every client with a health interview that starts with the preface, “Have you ever been diagnosed with or been treated for…” and ends with “Is there anything that I haven’t asked that might come up in your medical records..”, people will choose to leave something out because they don’t believe it’s relevant. When the medical records are acquired and the decline hits, the responses run along these lines. “I didn’t think anything mattered after 10 years”. “My doctor said I was as good as new after my heart surgery”. “Well, I didn’t think that was any of your business”. The quotes you receive and the end result are only as good as your honesty and forthrightness. Nothing is irrelevant until the underwriter says it is.
5. Alcohol abuse. When you drink heavily there is a high likelihood that your liver functions will be elevated. If liver functions are elevated on labs, it triggers the running of an additional test called a CDT. The CDT is an alcohol marker that, while not a diagnostic tool for alcoholism, is a very accurate test indicating whether a person is a heavy drinker. Suffice it to say that a glass of wine with dinner won’t impact your liver or show up on a CDT. A six pack a day is likely to do both.
I am often asked what impact a decline has on a person’s chances of getting insurance in the future. The answer, of course, depends. If the decline is for any of the reasons above and you don’t take care of the problem or become more honest, the result will be the same.
But often a decline by one company may get a completely different result from another company. Very often it is simply a case of the wrong agent taking your business to the wrong company. Could be that the underwriter just had an attitude or made a mistake. We are very successful at turning bad declines into good approvals. To me the nice thing about working a declined case is that all the cards are on the table and when I shop it, I know exactly what company to go to for an approval.
Bottom line. A decline on a life insurance application doesn’t mean you can’t get life insurance and many times you can end up with very reasonable rates. A good independent agent is needed simply because you want a broad range of companies to choose from and generally they will understand the steps to take with your initial bad experience.
June 11th, 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
Probably one of the most challenging parts of life insurance is explaining to clients why their, at least to them, seemingly innocuous health issue impacts their life insurance rates. Their belief is that if it isn’t bothering them too much and their doctor hasn’t told them to buy a house close to the emergency room, what’s the big deal?
Sleep apnea is one of those issues. In most cases of obstructive sleep apnea a person would probably claim that they had overcome their only real mortality issue, that being their demise at the hands of their spouse if they didn’t do something about the snoring.
The most common risk factor (cause) of sleep apnea is obesity. While it is not uncommon in other cases, it is a relatively frequent occurrence among those who have lost control of their weight. In most cases the issues that arise from sleep apnea, snoring and sleep deprivation, are those kinds of things that fall into the “so what” category when a person is trying to wrap their mind around their own perceived life insurance risk.
The issue that very often doctors don’t talk about with their patients is the connection between sleep apnea and CAD (coronary artery disease), stroke and congestive heart failure. It is my belief that most doctors aren’t real keen on attempting to help people get a grip on lifestyle issues, so they treat the symptom and don’t discuss the underlying causative issues.
There is a definitive link between these issues, although the still unclear factor is whether sleep apnea leads to an increased risk of heart disease and stroke, or whether it is obesity that is the real culprit. Studies are ongoing to determine that answer. The other issue of congestive heart failure seems to be very clear. While sleep apnea doesn’t cause CHF, it absolutely aggravates it.
From a life insurance standpoint, while none of these cause and affect scenarios are consistent from person to person, underwriting has to consider the issues. Sleep apnea, if well controlled, is ultimately insurable at very good rates as long as it is characterized after testing as mild to moderate. Severe sleep apnea is generally still insurable, but there can be increased rates.
Bottom line. It’s not your snoring that concerns life insurance underwriters. If you have sleep apnea and need life insurance, find an independent agent who understands sleep apnea. They will know what questions to ask and most importantly, what companies will help you and what companies to avoid.
May 24th, 2008
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