Posts filed under 'coronary artery disease (CAD)'
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
A perfectly healthy person who smokes can expect to pay, best case, twice as much as a person who doesn’t smoke for life insurance. I’ve been on that soap box often enough that I don’t know that I need to beat it to death anymore.
With that being said, there are other times when smoking can have an even more profound impact on underwriting. An underwriter I know and work with on a regular basis calls the extra premium or sometimes the decline that results from smoking in addition to certain health issues as a “you just can’t fix stupid tax”.
We’ll start with the flagrant examples and work our way back toward some of the more subtle. By the way, all of these examples are from people who have actually called me attempting to get life insurance. A person who has diagnosed COPD (chronic obstructive pulmonary disease) and still smokes has apparently missed something somewhere and is a slam dunk decline.
A person with an otherwise insurable history of cancer, if they smoke, would either suffer a much higher rating or be declined because they haven’t quite grasped the fact that there is a direct correlation between abusing your body and bad things happening.
One that comes up fairly frequently is the person who has suffered a heart attack or been diagnosed with CAD (coronary artery disease) and still smokes. Hellooo!!!! The doctor said you need to quit. Your wife said you need to quit. The surgeon general said you need to quit. Your mother is going to outlive you because you refuse to get a grip and do the right thing.
Asthma and smoking. Depending on the severity of the asthma, this can be reasonably insurable to highly rated. It’s frankly never made a lot of sense to me. If you have trouble just breathing air, why would you substitute smoke for air? Kind of like if you had trouble swallowing water, substituting mud.
Bottom line. Life insurance underwriting allows for insuring smokers in most cases. Higher rates will always apply when comparing smokers to non smokers. I’ve never been shy about ripping the heads off underwriters when I think they’ve got it wrong. When it comes to smoking combined with smoking caused or exacerbated health issues, I believe they’re right on target.
May 15th, 2008
Just as we’ve discussed so often, with any number of health issues from heart disease to cancer to diabetes, the earlier it is detected the better the chances of controlling or stopping it before it causes irreparable harm.
With diabetes there have always been the old standby warning signs like family history and obesity, but now a study has shown promise of a blood test that will possibly reveal markers for early detection of type 2 diabetes.
Since type 2 diabetes can lead to a whole host of other health issues (as if it weren’t enough on its’ own), catching it before it’s even had time to fully manifest itself could possibly give a person a chance to make changes that could head it off before it even becomes an issue. Finding these markers may even lead to breakthroughs in actual prevention.
From a life insurance view, type 2 diabetes, if well controlled and in the absence of other risk factors can still garner standard or better rates. The criteria in general for getting the best rates with type 2 diabetes are:
1. Age of onset after 50
2. hbA1c under 6.5
3. History of compliance with treatment
4. No other risk factors or side effects such as obesity, CAD, gluacoma, neuropathy, etc.
Bottom line. Don’t give up looking for life insurance if you have diabetes. Most companies don’t want your business, but a good independent agent will be able to steer you in the right direction.
April 29th, 2008
I have no idea, but if someone has had a heart attack I know that one thing that won’t hurt their feelings is finding affordable life insurance rates. While I may not have a clue about broken hearts, I can shed some light on what life insurance underwriters look for when underwriting heart disease and heart attack cases.
The difference in underwriting is very subtle between heart disease (CAD)
and heart attacks. The real difference has to do with the problem being diagnosed before or after damage (ischemia) has occurred in the heart. If the damage is minimal the underwriting outcome will be virtually the same. As the damage level increases, rates become higher due to the weakened condition of the heart and subsequent possible shortened mortality.
Having said that, life insurance underwriters look at several key factors in weighing the risk.
1. Age of onset. This one isn’t too hard to imagine the impact. Just consider for a moment the difference in your reaction upon hearing that a 35 year old cousin had heart bypass surgery versus hearing that his father, a 60 year old, had the same occurrence. There isn’t anything normal about a young person having cardiac issues, so age of onset is important to underwriting. Generally, prior to 50 is going to increase the rates and prior to 40 will increase the rates dramatically.
2. How many vessels were involved? Whether there was a heart attack or not, we are generally talking about either bypass surgery or placement of a stent through angioplasty. The number of vessels is some indication of not only severity, but chance of recurrence. A one vessel issue will receive more aggressive underwriting than, say, four or five vessels.
3. Recurrence. It is not uncommon with chronic CAD for a person to have to go through more than one procedure. If these are less than three months apart it is generally looked at as one event and wouldn’t be considered chronic. Often these occurrences are years apart and that presents an obvious increased risk to the insurance company. As long as the heart, as shown through the results of a stress test, is still strong, insurance should be attainable although at higher rates.
4. Heart damage. Before accepting a risk on a cardiac case, insurance companies will want to see a stress test done post heart attack/bypass/angioplasty. Even 10 or more years out from the event, if a person hasn’t had a stress test within the previous two years, insurance companies will likely require one before considering approval. The primary assessment of heart damage from the stress test is the left ventricular ejection fraction (LVEF). This, simply put, is a measure of how efficiently your heart is pumping blood. A normal LVEF would generally be around 65%-70%. Insurance companies will generally not consider coverage if the measurement is below 50%.
5. Lifestyle. Underwriters pay close attention to whether or not the event got your attention. If you’ve had a cardiac event and, say, continue to smoke, if you are approved it will be at an extraordinarily high rate. Most companies will simply decline to accept the risk. They also look at fitness issues such as exercise and obesity.
Bottom line. Fair rates on life insurance are available for the majority of people who have been through a cardiac event. Thanks to modern medicine far less damage occurs on average than used to occur. What this means for insurance companies is that, rather than knocking someone out of the running for life insurance, it keeps them in the running and with the survival of the wake up call and lifestyle changes, mortality experience is good. You’re going to be around for a while.
April 16th, 2008
In a post some months ago I was sharing some of my new found knowledge about ultra fast CT scans and their viability and dependability in detecting clogged arteries in the heart. Just to refresh a bit, the ultra fast CT scan hangs it’s hat on the ability to detect calcification in the veins and arteries.
The problem has been that the heavily marketed test
doesn’t seem to be as accurate as it’s wealthy marketers would like everyone to believe. The life insurance case I was working on at the time involved a person who had a very high calcification score, but after a complete cardiac workup including a catheritization, he was given a clean bill of health. The score was high but there was no clogging of the arteries happening.
That was kind of the big rub. The test is touted as a non invasive procedure to detect coronary artery disease, but its’ inherent inaccuracy leads to invasive procedures to determine if the results were accurate. Dr Joseph Mercola kind of summed up one view of this whole thing on his website, www.mercola.com, like this. “Every time a new non-invasive heart test is invented, it is hailed as bringing us one step closer to the day when invasive tests will no longer be necessary. And yet, as time goes by and the new non-invasive test comes into common use, more and more invasive tests end up being performed. This is not a mysterious or inexplicable result. It is entirely predictable.
So now I am working with a client who has high cholesterol and LDL rates and has an ultra fast CT scan result that has a calcification score of 0. Nada! I shopped this for him, and the companies that ripped the other client up due to his high score, refused to give any credit to this poor fellow with a score of 0. Not too surprising, the one company that discounted the impact of the first guy’s high score, gave this client credit for his low score. A thinking underwriting team. Keep those people on the payroll!
Bottom line. The test still hasn’t been scored when it comes to ultra fast CT scans. Before plopping down the hundreds it takes to get one you really should do some homework.
April 9th, 2008
There are essentially three treatment methods for blocked arteries of the type that can lead to a heart attack. The original and still widely used vessel bypass surgery, angioplasty with a stent inserted in the vessel, and for minor blockage, medication to reduce the risk of increased blockage.
A recent New England Journal of Medicine study showed that the conventional bypass surgery had a higher survival rate in multi vessel cases. While the difference isn’t huge, when it’s your heart and your life it certainly seems worthwhile to discuss the pros and cons with your cardiologist.
From a life insurance view, underwriting coronary artery disease generally focuses on four areas. Age of onset is huge. The earlier the diagnosis, the tougher it is to get good rates. A good rule of thumb is that the best rates will come with a diagnosis in your 50’s. Between 40 and 50 is still doable, but generally rated a little higher. The good news is that quite often the higher rating is offset by the younger age. Prior to age 40 and chronic instances are a tough sell. It can be done if the patient is doing all the right things.
The number of vessels is important. The more vessels that are blocked gives some indication of how pervasive the CAD is.
Other risk factors plays a key role. Probably the one combination that leaves underwriters asking “Where’s your sign?”, is someone who has been diagnosed with CAD and is still smoking. Other risk factors that don’t float with CAD are diabetes, high blood pressure and obesity.
Finally, the condition of your heart as measured by a stress test after you’ve completed whatever procedure you elect to have. Underwriters pay particular attention to the left ventricular ejection fraction (LVEF), a measure of how strong the heart pushes blood out of the left ventricle.
Bottom line. A good independent agent can find fair rates for people post bypass or angioplasty. The general rule of thumb is that underwriters will want to see a year after the procedure and a stress test.
January 24th, 2008
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