Sleep apnea is one of those health issues that can elicit anything from a best rate class approval to a decline depending on two things, which company’s underwriter was involved and if you are truly treating the issue seriously.
A layman’s sleep apnea definition might give the wrong impression of why underwriters are concerned. Apnea is actually a period during sleep when a person quits breathing. It is almost always, when they start breathing again, followed by a loud snore or gasping. Sleep apnea is not a mortality issue in the sense that people quit breathing and don’t start again. Think of it as a more severe instance like those when you have been reading or something relaxing and you just haven’t been breathing deeply, and you suddenly have the need for a good deep breath.
So the issue isn’t about whether a person will forget to start breathing or not. Our body takes care of that quite well, albeit a bit loudly. The real issues have to do with the stress put on your body by two things. First, especially in more severe apnea where a person can quit breathing up to 50 times per hour, there is an issue with a lack of oxygen during sleeping hours. The other is that sleep apnea simply disrupts normal sleep patterns and makes for a tired, sleep deprived person the next day.
So the real mortality issues become sleep deprivation and the possibility of a higher rate of accidents, and the oxygen deprivation causing high blood pressure, heart disease and stroke. The other less talked about mortality issue is that your spouse may cause you substantial harm because of your snoring.
So, what do underwriters want to see for optimal results? A good sleep study that defines the problem as mild, moderate or severe. Mild or moderate bring the best results from a rate class standpoint. Probably the biggest issue for an underwriter is what you do about the apnea and how compliant you are with whatever treatment is chosen. If you have a sleep study with a cpap on that shows the cpap reduces your instances of apnea to almost nothing, but you then only use the cpap once in a while, or half the night, compliance is poor and control isn’t good. You aren’t going to win any underwriter points. Surgically corrected obstructive sleep apnea, if success is documented by a study, can put you back into best rate class running barring any other risk factors, such as obesity.
Bottom line. There are real reasons for underwriter caution with sleep apnea, but if you are serious about your approach to treatment there’s no reason you can’t walk away paying very reasonable rates.
May 1st, 2009
Sleep apnea can be nearly a life insurance non issue if it is well controlled, or deemed mild enough by a doctor not to necessitate the need for using a cpap. But it can become an issue when it’s not mentioned to your agent prior to the application process.
I had a client recently who wanted to make some changes in the amount and term length of his term insurance. This is a client who, on the previous application, had received a preferred plus rating. I asked if there had been any health changes or health testing that showed anything abnormal since our original application and the answer was no, so we proceeded with the best price based on his apparently still stellar health.
Everything went fine until the company acquired his medical records and found that within the past two years he had been diagnosed with sleep apnea. Since this didn’t seem to fit into my questions about changes or tests I called to see if I had misunderstood him. When asked this time he indicated that he had been referred for a sleep study but was pretty sure he didn’t actually sleep long enough for them to complete a study and he said that no one had told him he had sleep apnea or that he should be using a cpap.
So I asked him, even though he said it wasn’t a complete test, where we could get a copy of what was done. A few days later he faxed me a copy of the sleep study and it definitely showed a diagnosis of moderate obstructive sleep apnea with a recommendation for use of a cpap and further testing on a cpap. Then came the confession. He disagreed with the doctor and the sleep study so he therefore decided it wasn’t relevant.
From the standpoint of a life insurance underwriter, if a test is done and you are diagnosed and treatment is prescribed, unless you get a second opinion (not your own) refuting the first diagnosis, it stands as a fact. Whether you agree with it or not isn’t swaying an underwriter and choosing to just ignore the doctor is a swift way to a decline. Just in case you might ever want to apply for life or health insurance, never ignore a doctor’s recommendation to get a test and never ignore the doctor’s recommendation based on the results of a test. You can disagree, but those recommendations stand in the absence of another doctor providing an over riding second opinion.
If he had told me about the sleep study and his decision to ignore it we could have saved him the time of a new exam and application. I would have made it clear that until the sleep apnea issue was dealt with, he should just keep his current insurance, which is what he is now going to do.
Bottom line. There is a time in all of our lives when we hear something from a doctor that we don’t like or we think is just wrong. We have to deal with it. In this case if the moderate sleep apnea was being treated, my client could have received the best rate class with Prudential.
April 22nd, 2009
