Posts filed under 'diabetes'
At least a dozen times a week I get an opportunity to review someone’s current and historical health with them. I’m on a fact finding mission with the goal of getting each person the best possible life insurance rates they can expect in their unique situation.
Sometimes there is literally nothing relevant to life insurance in a person’s own or family history. Sometimes there is plenty to discuss about both past and present health. It’s at this juncture when clients are put to the test concerning their knowledge about the health issues they have gone through or are presently dealing. A surprising number, or at least it’s always surprising to me, kind of generally know about their health but don’t know what risk factors it presents for them or how to measure whether or not they have their situation under control.
When my doctor tells me something new about myself, I’m a pretty curious guy. And with Google I can find out plenty of information in about .23 seconds. A good example was recently when I had a blood test result from our local health fair come back with a high TSH reading. With the help of Google I found out that TSH stood for thyroid stimulating hormone and that a high reading meant that it was possible my thyroid wasn’t working up to its’ capability. I visited a doctor and had it retested. It turned out to be a false positive test so everything was OK, but the point is that I knew what was going on, what it meant in the whole scheme of things and if it had turned out to be a positive test, what type of treatment and prognosis I could expect.
When I talk to someone with diabetes and they don’t know what their hbA1c is, it really makes me wonder if they care about their health. This is a critical test in life insurance underwriting and a critical test for measuring control of diabetes. How can a doctor not educate a patient and how can a patient not educate themselves on aspects of their disease that are as important as this?
It never ceases to amaze me that someone can go through something as traumatic as cancer diagnosis and treatment and come out of that process not knowing beans about the cancer they had. How do you know if your doctor is discussing all the options for treatment with you if you don’t know what all the options are? How do you know what the options are if you don’t know the stage and grade of your cancer? For all the bad things that might be said about the internet, it has put a world of knowledge at our fingertips.
It surprises me that someone who has had a heart attack or has undergone cardiac surgery will have a follow up stress test and take the doctor’s synopsis that the “results were good” as relevant. How can you have a test like that and not question the results and know what each result means? Were my results good compared to a person who has never had a heart attack? Good compared to a person who has had a heart attack with my family history? Good compared to your last patient who had a second heart attack and died a year later?
Bottom line. An independent life insurance agent can ferret out the good deals for you if they have all of the relevant information. Without it it’s a roll of the dice. Quite often the information you provide will lead to or rule out specific companies. Two things. If you’re going to shop for life insurance, take the time to know about your health issues and, if an agent asks you to do some homework for specific information, do it. If they are asking for specific information they probably are an above average agent with an above average chance of getting you what you need.
July 20th, 2008
This is an area involving life insurance that is receiving more and more attention and a topic where the troops (life insurance agents) are definitely divided. A life settlement involves the sale of your policy to a third party. The third party takes over ownership, future premium payments and becomes the beneficiary of the policy.
Why would a person consider a life settlement? Two reasons really. This generally involves term insurance and a person may simply not need the policy anymore. If a policy was, for instance, purchased to cover a key person in a company and that person has retired, the company may wish to recoup some of their premium payments through the sale of the policy.
The other reason is simply that the owner of the policy needs money and sees the sale of the policy as an easy way to get cash. This can be an unfortunate choice when long term family protection is bagged for a short term cash fix.
A few things about life settlements. First, the policy has to be within the conversion period. The new owner needs to be able to convert the policy in order to keep in force until your death. Second. You really need to be sick to get any significant amount of money out of a policy. A healthy 65 year old, if they are offered anything at all, won’t be offered much. I have seen this process of elimination work and the companies who do life settlements evaluate a case and determine, at least to the satisfaction, how long they believe you will live, down to the year and month. They then base their offer to you on the face amount, minus what they will have to pay in premiums on the converted policy, minus a healthy (very healthy) profit.
In most cases, in my opinion which happens to coincide with a large number of financial advisers, if you are sick enough to get a worthwhile life settlement, you are better off converting and keeping the policy yourself. Your family will net more benefit almost every time.
Then there is my own bit of discomfort with life settlements. Life insurance is all about mortality assumptions based on statistics that have been built up over long periods. Underwriters use assumptions when deciding rates for people with heart disease, diabetes or a history of cancer. My discomfort with life settlements is that there are no mortality studies that I’ve been able to find for people who sell their life insurance policies to a third party.
This country harbors one of the greediest corporate mindsets on the planet. If a life settlement group has a large block of business and profits aren’t where they need them to be, who’s to say, especially in today’s unemployment situation, that $500 here and $500 there might not hasten the mortality experience a bit. I’ve had plenty of viatical and life settlement agents tell me that assumption is hog wash and I would suggest that they allowing their greed for the sale to overwhelm their common sense. People get rubbed out in this country all the time for a lot less than hundreds of thousands or millions of dollars.
Bottom line. As for me and my agency, we will not recommend or participate in life settlement business.
July 17th, 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
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
I have written in the past about life insurance underwriting on type 2 diabetes and also on heart disease. I think I have been very clear about the fact that life insurance underwriters are adamant about good control of diabetes and also we’ve discussed the problematic underwriting of the combination of diabetes and heart disease.
We’ll see where current studies guide diabetics and how underwriters react, but one recent studysuggests that type 2 diabetes, well controlled or not, results in a high occurrence of heart disease.
Heart attacks and strokes are the leading cause of death among type 2 diabetics and the ADA suggests that the rate of death among diabetics due to heart disease is possibly as high as 75%.
All of that is to say that perhaps life insurance underwriters are putting to much emphasis on driving glucose numbers down, possibly putting too high an emphasis on a low hbA1c. Current studies would indicate that may be the case, but don’t look for underwriters to jump on the bandwagon until more conclusive results are brought forward to back up the initial findings. I can see any changes going one or two ways. They may become less stringent about glucose levels, but may adjust mortality tables to reflect the high occurrence of heart disease in diabetics.
Currently the most critical underwriting factors for diabetes are age of onset, level of control as measured by the hbA1c, and any complications that have manifested themselves due to the diabetes such as neuropathy, retinopathy and heart disease. The best underwriting and rates would go to late onset (after age 50), an hbA1c of 6.5 or under and no complications.
Bottom line. The studies throw out some pretty sobering news and also, I think, some very useful news for those who have been battling to drive down their glucose levels. I’ll keep you posted as to any changes we see in underwriting guidelines, but as I said, I suspect those changes will be slow in coming.
June 7th, 2008
There is a common misconception that has floated around for the past 100 years or so of my life that if a person has cardiac problems, a heart attack, or coronary artery disease (CAD) requiring heart bypass surgery or an angioplasty, they are irreparably damaged in their ability to get life insurance, especially affordable life insurance.
This isn’t a simple thumbs up or down issue, but generally speaking in the absence of severe damage caused by a heart attack or chronic CAD requiring multiple procedures, insurability is not an issue. It will absolutely be at higher rates than someone who hasn’t had any cardiac issues, but affordable in most cases.
Some of the things that underwriters look for in heart attack cases would be:
1. Age of occurrence (better after age 50 than before)
2. Risk factors (obesity, high cholesterol levels, family history, high blood pressure, etc)
3. The amount of damage (usually measured on a stress test by the left ventricular ejection fraction (LVEF). Over 50% is insurable. Under 50% generally not, but would be weighed against offsetting factors.
In the case of CAD in the absence of a heart attack underwriters look at:
1. Age of onset (again, better after 50, not so good before 50, very challenging before 40)
2. Number of vessels effected (blocked). A single vessel blockage is better than what would be considered a more aggressive or pervasive multiple vessel blockage.
3. Again, risk factors. What underwriters are looking for here is whether your risk factors will tend to push you toward chronic CAD. If you have a good build and get plenty of exercise and do what it takes to control cholesterol and blood pressure, that’s a good thing. If you are overweight, don’t exercise and don’t get your cholesterol and blood pressure under control, the risk you pose to an insurance underwriter is much greater.
4. Underwriters will want to see a stress test usually at least 6 months to a year post procedure to determine the extent of any damage and how well the repair job went.
In spite of the myth, heart issues are insurable and usually at affordable rates. If you are applying for insurance, be prepared to answer the questions posed above. Know your cholesterol. Know your blood pressure. Know what meds you are taking. Know the date of your last stress test and get a copy of it. It is much easier for an independent agent to successfully shop for you armed with facts than being armed with generalities (the doctor says I’m doing fine). It would be a rare person who would know and a rare doctor who would discuss your LVEF. Underwriters have to know it in order to assess your application correctly.
Bottom line. If you’ve had a cardiac event, don’t throw in the life insurance towel. First and foremost, don’t go to your local State Farm or Farmers agent with your desire for life insurance unless you have a fondness for rejection. An independent agent will have access to companies that understand the underwriting of heart issues and provide your best possibility of success.
June 6th, 2008
Everyone believes they should get the preferred plus rates that are advertised everywhere. “Di you know that John can have $500,000 of term life insurance for just $12 per month?”. The truth is that many qualify for those rates and get them, but for the average person with average health issues, we don’t.
Probably the quickest group to rebuff anything but a best rate approval on life insurance are those folks that are overweight and know they’re overweight, but simply don’t see it as an issue. It has been my experience that this group, more than any other, seems to have a firmer grasp on denial than most. They, inspite of knowing the link between obesity and other health issues, don’t believe it is fair for them to be charged more for life insurance than someone who is fit and taking care of themselves.
Now let me be clear about this. Using a body mass index calculator I appear to fall into the overweight category at 5′10 and 175#’s. But insurance companies aren’t abusive about the build issue. With most companies, even though I am clearly in the overweight category, would actually allow another 20#’s or so before they would bump me out of the best rates as long as I didn’t have any other health issues that would preclude that.
Having said that, 5′10, 220#’s is going to catch the prize with any company. They aren’t going to care if that is the same weight that you played football at in high school. They aren’t going to care if you work out five times a week or run five miles a day. They aren’t going to care if your health is perfect in all other aspects. Obesity is obesity and along with it comes substantially increased risk of health issues that have the ability to shorten your life span and assessing your mortality risk is what life insurance underwriters do.
So, the folks whose weight (or lack of height) doesn’t get them what they want, in general, will blow off whoever is honest enough to tell them what insurance will really cost, and go on to another agent. Many are apparently so offended, in my experience, by honesty that they will never return a call again. It’s as if I called them fat or ugly or something, when all I really did was gave them an accurate quote. To them, possibly it feels as though I am just one more person in their lives who is treating them unfairly.
I don’t know what is going through their minds really, because they don’t call back to discuss it.
The truth is that the rates are fair based on build and that evenly the morbidly obese can put together a plan of life insurance that should fit into their budget. The challenge is to get over the fact that weight is an issue and it’s not going to change and work with your independent agent to find the company and the plan that will work best for you. There is not a cookie cutter interpretation of the weight issue from company to company and there are good rates to be found.
Bottom line. With obesity ranking high among the leading causes of type 2 diabetes, heart disease and cancer, underwriters can’t afford to ignore weight. Even if those health issues are currently present, you are at a greater risk than the average sized person of coming face to face with one, or more of them.
June 5th, 2008
In my last post I hope I made a clear distinction between a life insurance agent who is qualified to handle cases that involve health issues, and those who really shouldn’t play with sharp objects. At the end I alluded to the definitive way to separate the two groups.
First let me broach the subject of bait and switch. Baiting, telling the client that they qualify for a rate that they don’t, is a way to get the application. Getting the application is a way to get anyone who told you the truth out of the picture. Let’s say I quote you $1200 a year for a term insurance policy. I’ve presented my quote based on the fact that I know you have type 2 diabetes that was diagnosed at age 51 and we reviewed your last set of labs and I know that your hbA1c was 6.4. Another agent quotes you the same policy for $800 a year. Most people will jump on the less expensive band wagon and won’t even talk to me again.
The switch is when the policy is approved. Generally, because a bait and switcher just goes with their favorite company (where they get the highest commission), the approved rate will come back even higher than what I quoted. The B&Ser will come up with some song and dance about why the rate changed and then, having just drug you through a 2-3 month application process, suggest that unless you want to start over and take your chances, this is really as good as it is likely to get.
I know you’re all sitting there saying that you wouldn’t fall for that, but the truth is that bait and switch is alive and well because most of you will accept the higher priced policy rather than start over.
You sound mean, but you’re not.
Which brings me to the magic bullet. How can you weed out the B&Ser right up front? How can you tell if they’re telling the truth or just low balling a quote to capture the application? The bullet is called a trial offer. They way trial offers work is that, for instance, I would send an email out anonymously to the underwriters from all the companies I represent. The email might go something like this:
Proposed insured born 3/14/53, 5′10, 175, non smoker. Diagnosed 4 years ago type 2 diabetes. Most recent a1c 6.4. No other risk factors. All other labs normal. Good family history. Takes 500mg Metformin daily. Looking for $500k term insurance.
Insurance underwriters respond, always with the caveat that any final offer is subject to an exam and a review of medical records. There offers, and these are actual insurance company responses, come back like this. “Tentative ok without a rating if fructosamine is normal”, “Very tentative Standard No Nicotine subject to app,exam,labs,EKG and APS (attending physician statement)”, “Our tentative quote is Standard (due to glucose)”. Once received, we know which company will ultimately provide the best approved offer.
So here is the way to ferret out the bait and switch agent. If you are shopping for insurance and you have health issues, and one quote comes back significantly lower, insist that they provide you with a copy of the trial offer from the company they are quoting. If they don’t have one, they don’t know what they are doing. If they try to tell you that they don’t need one or that companies don’t really honor trial offers, they don’t know what they’re doing. And ultimately, if you think there is some chance that they might come through, apply with them and also apply with an agent who can produce a trial offer, and do it concurrently. Simply let the agents know that it is your intention to accept the best offer after underwriting. That’s fair. Smart too.
Bottom line. The life insurance industry has it’s share of slime balls and their favorite sport is bait and switch. You now have the ultimate weapon for stopping them before they can get you to join their game. Do you want a low quote or an honest quote? Do you want the policy to be approved with no surprises? Do you want to deal with an honest life insurance agent? You decide the game you’re going to play.
May 28th, 2008
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