Posts filed under 'diabetes'
Talk about a topic that has changed with the wind over the years, diabetes underwriting would be that animal. There was a time not all that long ago, at least if you’re my age, that diabetes was treated by most companies with a swift decline and by the few that would entertain it, with extreme caution (read that higher rates).
In the last 6-7 years we finally found some sanity on the subject with US Financial Life. They were the first so called clinical underwriting company. In a nutshell that meant that they didn’t treat all people with diabetes the same. If you happened to have type 1 or type 2 diabetes and were doing all the right things to take care of yourself, they would often hand out approvals at their preferred rates. That was the good news. The bad news is that they caved into a buyout offer by giant AXA Equitable. When all was said and done, they dismantled the company and the progressive underwriting and left it as a fond memory.
Since then we have had beacons of hope in companies like Banner Life. Banner briefly stepped out there and said they would offer their best rate class given strict guidelines. They wanted to see age of onset past 50, no other health issues or risk factors, and an hbA1c in the borderline area, below 6.0.
They soon revised that from their best rate class to standard plus, still a breath of fresh air. In premium dollars their standard plus was actually competitive with the old US Financial preferred so it seemed that even given their swift back step from preferred plus possibilities, we still had a competitive direction to go. That was last year.
Fast forward to now. Banner Life is still the one to beat out there although they have tightened on their criteria a bit more. That has brought companies like American General (yes, they’re still a good company) and West Coast Life into the mix.
Bottom line. Type 1 diabetes has become a tougher hunt than it used to be, but still not impossible. The companies that do entertain underwriting the condition are very cautious about collateral health issues. Type 2 diabetes remains a very competitive market which means there are good rates available. Seek out a good independent agent to find out what all of this means for you or your loved one.
October 6th, 2008
This is mostly a rhetorical life insurance quiz for guys. There are no guarantees that you will be approved for life insurance at all, although most are. And there certainly aren’t any guarantees that you be approved at the rate class you applied for.
All of us, except me, really want and kind of expect to be approved at the best rate class. I’ve kind of given up on that best rate class. I got it once several years ago, but age and a few health issues have moved me down the food chain a bit. You’ve seen the commercials. “A 45 year old man can get $500,000 of term insurance for just $27 per month”.
If you’re fast enough and if the people doing the commercial were honest enough you would catch the fine print going something like, “for a 10 year term as long as you fit into our build chart, don’t have any family history of heart disease, cancer or diabetes, have never seen a doctor for anything other than a cold or flu, don’t take any prescription medications, have never been arrested and have a good driving record, don’t have any hobbies more dangerous than putt putt golf, don’t travel to foreign countries that don’t love Americans (that would be none this week), and don’t drink too much or do drugs”.
There are a lot of people who fit that criteria and get the best rate. It is not, as some like to say, a Superman rate. It is simply held out there for those who are healthiest. So what happens when you have your heart set on $27 per month and your cholesterol is too high or your family history prevents you from getting that approval?
Well, a lot of people, especially guys, like to take their bat and ball and go home. They would literally rather go without than pay a rate that is higher than they think they deserve. This has always seemed like such a bizarre stance to me. “I can’t get the best rate, so if I die I would rather my wife has nothing!” That just seems a bit on the childish side to me.
Why not, if you had your heart set on $27 a month for $500,000, and you get approved and all that $27 will buy is $400,000, take it. That’s taking responsibility by the horns and letting your loved ones know you love them more than you love yourself.
Bottom line. Something in force is always better than nothing and if it’s a health thing like cholesterol that kept you from getting what you wanted, put as much as you can in force and work on that health issue. Far better to work on health things with life insurance in force than not.
September 29th, 2008
Remember the good old days when livers were done in by drinking too much? Cirrhosis of the liver can eventually lead to liver failure or liver cancer, kind of a no win situation unless you have a spare hidden in the closet.
Now studies show that obesity can lead to a situation called non alcoholic fatty liver disease, which left unchecked (you don’t lose weight), can lead to cirrhosis, failure and cancer and eventually to that hunt for a spare liver. This is becoming alarmingly frequent in young people who, unfortunately, are rarely tested for liver functions.
I will continue to beat this obesity issue to death just on the off chance that someone, even if they aren’t in the market for life insurance, will read and learn that the number of ways that those extra pounds can kill you is simply staggering. Diabetes, high blood pressure, heart disease, stroke, several kinds of cancer and yes, liver disease.
Just a few plugs for common sense. If you are obese and don’t have any of these things going on yet, buy life insurance now. If you are obese and can’t lose weight through traditional methods, seriously consider gastric bypass. Forget those people who say that’s just taking the easy way out of your problem. This is about your life and saving it. Just consider it. Talk to your doctor.
Bottom line. The weight of obesity is crushing our nation and especially the young people. Overweight teens have no concept of the problems they will be facing in their 30’s and 40’s if they don’t do something now.
September 9th, 2008
It’s always good to talk to people who have come through major health issues like heart attacks or cancer and have taken the bull by the horns and made life style changes that will likely add years to their lives and a bonus of quality to go with it.
Then there are those who make the life style changes and assume that they are now bomb proof and have elevated their health profile to the point of not needing medical checkups. I shared in a post some time ago about a man who had colon cancer, at the time, 14 years prior to our speaking. They did a surgical resection of about 12 inches, chemo and radiation. When I spoke to him he had never been back to the oncologist and had not had a colonoscopy since the end of treatment.
More recently I was talking to man who had suffered a heart attack about 5 years ago. He was very quick to point out that the whole thing had changed his life. He now ate the right things and had become a runner, running 8-10 miles a day and occasionally participating in marathons. When I asked him when his most recent stress test was, his answer was today. He painted a picture for himself that by running every day and surviving, he had moved beyond the need to have a medically monitored, imaged stress test as part of a post cardiac event followup.
This logic won’t win any points with life insurance underwriters since they jump all over the obvious given a chance. Yes, that 8 mile run is a stress test but it doesn’t tell you anything about potential new blockage that may be building. So, surviving his stress test may in fact mean that he is completely healthy and will never have a problem again. It might also mean that, by ignoring the medical facts that caused the first heart attack, he is just one 8 mile run away from the 2nd heart attack.
Being a runner (jogger/waddler) and always being fascinated by the guys that could really run fast, I have noticed over the years that those distance runners that have heart attacks while running don’t seem to have a very high survival rate. I’m just guessing, but I wonder if that has something to do with the attack happening when your heart is pumping hard to start with. Seems to this layman that it ought to cause more damage than if you are, say, sitting down with an average resting heart rate.
Bottom line. Lifestyle changes are to be praised. I always admire someone who has seized their life back by kicking obesity or diabetes or cancer. But life style changes should always be in combination with prudent medical followup. Underwriters will insist on it and you will thank yourself. If you find that you are right on track, it’s a great chance to share that with others and help them make healthy changes. If you find out something is sneaking back up on you, you just avoided ending a run in an ambulance.
September 8th, 2008
To me it is amazing the number of people with type 1 diabetes and type 2 diabetes who not only can’t tell you what their last hbA1c level was, but honestly don’t know what I am referring to when I am gathering information vital for finding them the best possible rate for life insurance.
Before I lay all the blame on the folks that have diabetes, allow me to spread it around just a bit. We do have a real problem with doctors who either don’t want to take the time to educate their patients, or don’t think their patients are intelligent enough to understand the importance and significance of glycosylated hemoglobin. Again, I don’t know if it’s a time thing or if doctors really do want to keep their clients in the dark so they can just keep on treating. It seems to me if you give a type 2 diabetic enough knowledge about the disease, the risk factors, how to manage and how to monitor, they might just end up cured.
But back to the other side of the coin now. Now that we know doctors aren’t taking the time, patients have to educate themselves. If you have diabetes and don’t educate yourself about it, you might never understand that there is a way off that merry go round.
So, why is you hbA1c so important to life insurance underwriters. Unlike your daily or more often glucose tests, he hbA1c can give an underwriter a clear picture of how your glucose levels have done over a 2-3 month period. Let’s face it. People aren’t out looking for high readings when they check their glucose, so they tend to take it at times when it is naturally lower. The hbA1c takes that factor out of it. If you normally check your glucose first thing in the morning and it is 120 but you never check it right after lunch when it is 250, you have kind a skewed view of your diabetes control.
Underwriters know that part of the story isn’t known or isn’t being told when an applicant says their average glucose is 140 and their hbA1c on the labs is 8.4. Somewhere in between this 140 and the next 140 are scattered some dangerously high readings. If your doctor tells you about the hbA1c or if you educate yourself about it and ask your doctor to tell you what it is each time he does a full blood workup, you can fill in those blanks and know if you are headed toward other health issues brought on by out of control diabetes.
Bottom line. Ultimately the ball is in your court. I would guess that 75% of those with diabetes that I ask about their A1c, don’t know it or haven’t heard of it. Not just for the sake of better life insurance rates, but for the quality of your life, or your life itself, it’s time to wake up and learn about your disease. Make it your goal to learn enough to manage your own diabetes right back into the closet it came from.
September 8th, 2008
I feel like a myth buster today. I was speaking with a woman today who made it very clear that she didn’t want to apply for life insurance if there was a chance she would be declined. Here reason is that life insurance applications ask if you’ve ever been rated or declined for life insurance before, and a logical person would assume that the question, if answered in the affirmative, would simply lead to another decline.
So let’s bust that myth. Yes, they do ask the question as part of their information gathering process, but if the decline was due to a difference in the underwriting guidelines between the new company and the declining company, there will likely be a different outcome. To further insulate you from that question, the new company you are applying with will look at you based on the merits of your exam with them, your medical records as interpreted by them and how all of that information fits within their underwriting guidelines.
There are plenty of companies out there who ask us agents to bring rated and declined cases to them for a fresh look. The truth is that there is an ocean of difference in how health issues are perceived from company to company, and sometimes there are fairly significant differences from one underwriter to the next within a company. A decline is not a black ball in the life insurance business.
Those of us who have staked our territory in the impaired risk business (anyone who doesn’t have a perfect health history) have studied long and hard to know what to do with your decline. We don’t get paid unless we succeed, so we aren’t going to fluff you up and provide quotes we don’t honestly believe we can come through with.
We also make our customers work harder than the average agent. If you’ve been declined, it will be a team effort that turns that around. We may ask you to get us a copy of your last stress test if you have heart disease or another heart problem like arrhythmia. We might ask you to get a copy of your pathology report if you’ve had cancer. Any agent that understands diabetes will ask for your last set of labs if you’ve been declined.
We want to succeed and being armed with all the information available is the best way to do it.
Bottom line. A decline is not an industry statement. It is the opinion of one underwriter and medical director in one company. Don’t hide because of past declines and don’t fear being declined. A decline may be just what it takes to get you headed in the right direction. I would be remiss if I didn’t throw my stander disclaimer out there. Don’t take your decline to your local auto and homeowners agent unless you are fond of rejection. You need to enlist an independent agent and they should be able to explain to you exactly how they will succeed where others have failed.
August 27th, 2008
Virtually all life insurance companies take your immediate family health history into consideration at some level. They don’t all view it the same and they certainly don’t all treat it the same, but it is in their guidelines and they seldom waiver.
This probably ticks people off far more than finding out something is wrong with their own health picture such as having high cholesterol on the life insurance exam or perhaps high blood pressure. Probably one of the toughest for a client to swallow is when a company penalizes them because a parent who smoked dies prior to age 60 of lung cancer when the client, having watched that whole scene, has never touched a cigarette. Another that is just about as tough a pill is when their rate is effected because their father died of a heart attack at age 48 after drinking, smoking and eating their way into the obesity hall of fame when they don’t smoke, don’t drink and exercise regularly.
So, is it fair? Well, the way I see that is if it happens to me, then no, but if I’m a life insurance underwriter, then yes. I have discussed this at length with underwriters and they understand that taking a black and white stance on family history will be unfair to some. But, any underwriting guideline that is black and white and produces the same result for a rate class for everyone, is going to be unfair to some.
Just a few examples of the latter and then back to family history. All companies use build charts and approve rates based on your build. They know that plenty of people who are 5′10, 250# live to ripe old ages, but they also know that at that weight the chances are much greater of having diabetes, heart disease and cancer. All companies test for cholesterol and approve rates that reflect your cholesterol numbers. They know that plenty of people with high cholesterol never develop heart disease or have heart attacks, but they know that the chances are greater of that happening if you have high cholesterol.
So, family history. Even though your father appeared to have done himself in by smoking, drinking and eating doesn’t mean that you are not genetically predisposed to heart disease. And just because you don’t smoke like your parent who died from lung cancer doesn’t mean that you aren’t genetically predisposed to cancer.
The good news is that, as I mentioned up front, not all companies share the same beliefs, and a good independent agent can usually find a company that will take most of the sting, if not all of it, out of any family history issues.
Bottom line. Rather than taking offense or trying to justify family history, ask your agent how they can take what you have and make it work for you.
August 20th, 2008
In previous posts I have touched on studies that have shown that the dramatic weight loss provided by gastric bypass surgery has proven to have much more value than just a matter of convenience in losing weight.
With the primary risk factor for type 2 diabetes being obesity, and two of the primary causes of heart disease being obesity and diabetes, there is a point where getting rid of the weight is a matter of life and death, and gastric bypass isn’t just a matter of convenience any more than stepping off the tracks when a train is coming is a convenient way to keep your clothes from getting messed up.
I spoke with a client within the past week who had achieved a 130 pound weight loss after gastric bypass. He was being treated for diabetes before the operation and weighed over 300 pounds. Within a few weeks of the surgery his glucose levels were lowered to the point where he was taken off medication. Even off medication his glucose levels never went back up. Now, three years later, at 187 pounds, he is cured of diabetes and has a new lease on life.
Life insurance underwriters are cautious when it comes to gastric bypass because there are some dangers and also, if a person doesn’t have the will to make the lifestyle changes, even gastric bypass can be overcome by slowly stretching the new smaller stomach back out. For this reason underwriters want to see a track record of stability in weight before they will call it a home run. Having said that, those underwriters are keenly aware of and ready to reward the new lifestyle and the risk factors that have gone away because of it.
Bottom line. Eliminating risk factors through life style changes is the right thing to do even outside the scope of life insurance. Quality life and a longer life are a blessing to share with your family.
August 16th, 2008
Life insurance agents don’t usually get paid unless they make a sale. This can sometimes cast us in a shady light if the application doesn’t go as planned and we start offering alternatives. People perceive us as doing what it takes to salvage some income out the whole deal.
I am not going to speak for all life insurance agents and claim that all of them take the moral high road and the client’s interests are always first and foremost, but as for me and my business that is absolutely the case. I want to share a story that happened last year and was brought full circle on Monday.
I was working with a couple in their 40’s, engaged to be married, and they wanted to take the step of getting life insurance. Everything went fine with her application. A picture of perfect health and no surprises. His application was another story.
We knew going in that he was overweight and had quoted the case based on build since there were no other health issues that he knew about. Once he completed the exam we found out, well, that it was a good thing he took an exam. His cholesterol was approaching the 300 mark and, based on his hbA1c, his glucose was elevated enough that he would be considered by most doctors to be diabetic. So, overweight, high cholesterol and diabetic led to an underwriting decision that raised the rate substantially.
He had originally applied for 20 year term insurance. My recommendation was to initially put a 10 year term in force to keep the price down. Once he made the changes to get his cholesterol and glucose and hopefully weight under control, we could apply again and get a better rate class and a longer term. Even the 10 year term price was more than he had expected to pay and he really just wanted to put it all off until he got things under control. He didn’t have other life insurance in force, so I made my best case for the logic of having insurance in force when you are doing battle with health issues, and especially potentially serious health issues. He finally conceded that it probably really was a good idea. We put the 10 year term in force for just over $800 per year.
His fiancee called me Monday, almost a year after we put his coverage in force, to let me know that he had died suddenly the day before. There is an autopsy pending, but I suspect what will be found is that all of those risk factors, obesity, high cholesterol and diabetes, led to a heart attack.
Bottom line. The good news is that we are now talking about processing a claim versus what he should have done. It really wasn’t about me and my next paycheck. It honestly is a real concern for those who would joust with health issues without insurance. This story is tragic, but there is something of a good ending. Over the years I have seen far too many that were tragic and ended with no insurance in place.
August 6th, 2008
Guys, we’ve talked about this before, an area where women don’t even have to struggle at all to make us look like morons. Unfortunately far too many men find out the value of an annual physical, a regular checkup, when they discover that they have a serious health issue that might have been avoided or at least discovered earlier if they had a relationship with their primary care doctor.
I don’t have to search far to find the truth in this. In just the last 10 years, the number of men who have applied for life insurance through me only to get declined because of medical information they should have known has been, well, larger than most men would guess. The medical exam and lab tests that come with applying for life insurance are quite often the first thorough workup men have had in years. To their dismay it often answers the question about why they haven’t been feeling up to par lately.
All of these things are simple and relatively inexpensive to test for when you consider the high expense of treating the aftermath when things get out of control. Probably the most common thing that pops up is high cholesterol, a leading cause of heart disease. Caught early, minor lifestyle changes can usually turn the problem around. When the problem is discovered after things are out of control, it is often a far more serious matter.
Diabetes is a fairly common discovery on insurance exams. Again, any kind of regular checkup would have revealed a level of pre diabetes that could have been treated with lifestyle changes. It is not an unusual occurrence for men to discover that they have prostate cancer due to an elevated PSA on their insurance exam.
One issue that pops up with regularity that doesn’t even require an exam is the discovery that both men and women find out that they weigh significantly more than they thought they did.
All of that is to say that having regular visits to your doctor, for obvious reasons, is something that insurance companies like to see. It is safe to say that the majority of life insurance companies, if you are over age 50, would prefer not to even consider your application if you haven’t seen the doctor in the last 2 years. There is only one company I know of who will consider your application under those conditions if you are over 60.
Bottom line. Guys would prefer not to see doctors unless they are dying. This really presents a poor risk to insurance companies. Since insurance companies aren’t likely to change, men, maybe we should consider conceding to women that they are right on this issue.
August 4th, 2008
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