Posts filed under 'heart attack'
I know for me that I consider daylight savings time to be a personal attack on my well being, and now there are studies to back it up.
There has always been an acknowledged link between sleep deprivation and heart attacks, so it really wasn’t rocket science when someone figured out that the onset of daylight savings time each spring caused a several day spike in heart attack incidents.
I suspect if I suffered a heart attack around the onset of daylight savings it would be more out of pent up anger than sleep deprivation, but that’s just my personal whine over the whole subject.
But buried in this whole idea is a life insurance underwriting issue, and a health issue worthy of discussion. Sleep deprivation is obviously caused by more things than daylight savings time. Stress and anxiety are huge players in sleep deprivation as is sleep apnea which interrupts sleep frequently on a nightly basis. While there is no question on a life insurance application about how much sleep a person gets on average, there are questions that cover most of the normal reasons for sleeplessness, such as history of sleep disorders, chronic pain, stress, heart disease, depression, or arthritis.
There is even the vicious cycle of sleep deprivation leading to obesity that leads to sleep apnea which leads to more sleep deprivation. Yikes!
Of course what life insurance underwriters look at are the individual health issues and try not to make leaps of assumption like, bad night’s sleep equals heart attack equals decline.
Bottom line. What it does bring to light is the interconnection between one health issue and another. Things like getting a good night’s sleep can’t be poo-pahed away as unimportant.
February 19th, 2010
Family history is one of those issues that just isn’t much fun to explain and frankly, from a life insurance underwriting standpoint, is a little hard to make a mortality risk case for more often than not.
Now I’ll give the actuaries the benefit of the doubt when, let’s say, a male age 40 is being treated for blood pressure and cholesterol, and maybe he’s a bit on the obese side and his father died in his mid 40’s from a heart attack. I can see the link. I can see how an underwriter can foresee a possible progression in that story.
But when that scenario gets the same treatment as a male age 40 in perfect health whose father died at, say, age 58 or 59 of a heart attack, is that really right? Can’t we give the guy that’s got his health locked in the benefit of the doubt?
Let me clear a few things out of the way before we come back to that. Family history of cancer doesn’t have to be an issue. ING Reliastar doesn’t factor cancer into their underwriting. Sibling family history doesn’t have to be an issue. American General and ING Reliastar don’t underwrite sibling history. The family history of a parent dying of a heart related issue prior to age 60 can be ignored by West Coast Life if the proposed insured is over age 60 or with Genworth Life and Annuity if the PI is over age 65. Those things don’t take exceptions.
Occasionally you can get a guy like the second one I described above some slack if he has had a full cardiac workup to rule out any heart issues. That would be an exception and it is an exceptional day when we can get an underwriter to buy it.
But today I spoke at length with an underwriter with an A+ rated company (different A+ company than the aviation post I wrote earlier) and he said that if a client would qualify at preferred select (best rate class) in all other ways (without a cardiac workup), they will ignore the parent dying at age 58 or 59 of a cardiac event. Small window of opportunity, but it’s huge. With all other companies, unless you can get an exception with a cardiac workup, that would be their third best rate class.
In real numbers! Let’s say the client is 50 and wants $500,000 of 15 year term. At the third best rate class they would be looking at $1100 to $1200 a year for that policy. With the company I am talking about, if that parent died at age 58 or 59, less than $800 a year. That’s not chump change.
Bottom line. Like I said, small window, but…..so many people get shoved into the wrong company over this issue, and they don’t have to. If you fit the criteria above and your agent insists that the third best rate class is as good as it gets, you have the wrong agent.
February 1st, 2010
Part of the life insurance business is helping clients understand that companies weigh the mortality risk of each client, and the higher the risk, the higher the premium.
I’m often asked by, say, someone who has experienced a heart attack, why the insurance company doesn’t just exclude death due to heart attack and give them great rates anyway. After all, health insurance companies and disability income policies often have an exclusion for pre-existing conditions. With life insurance they either accept you as a risk or the decline to accept the risk completely. If they accept the risk it is priced by their actuaries to include acceptance of any health issues that are known.
I know first hand that it doesn’t feel fair when a health issue, especially a well controlled health issue, prevents you from getting the best rates, or at least better rates than you were approved for. I have a condition called Raynauds that has kept me from getting the best rate class on prior applications for my own insurance. Raynauds is syndrome that causes the small capillaries in my hands and feet to constrict when I get cool. I get cold fingers and toes. Not exactly a mortality issue, but there is a one in a bazillion chance that the Raynauds could be the “R” is CREST syndrome. CREST is really bad and it will kill you before you reach your 60’s in general.
After nearly 30 years of Raynauds and no sign of CREST, my doctor tells me that the chances of developing CREST are really non existent. But, it still effects my rates. Fair? I don’t think so, but it’s not my money that will pay out the millions to my wife if I die.
They have to weigh the risk and in order to understand why some pay more than others it really helps to put it in the context of, what if it was your money? Would you really charge the same for a completely healthy 45 year old male and a 45 year guy who has diabetes and is 50#’s overweight. Yah! Me either.
Bottom line. It might not ever feel fair if you don’t get the rate you want, but underwriters really do work hard to get you the best rate they can justify. In combination with an independent agent that knows where to find the best underwriting for any given issue, you can be assured that you won’t have to spend any more than is absolutely necessary.
January 16th, 2010
It’s that time of year when fall starts giving way to winter and we get those giant wet snowstorms that turn many from sedentary leaf peepers into snowplows.
It’s also prime season for people to visit the ER with heart attacks or heart attacks symptoms that turn out to be some other thing they’ve strained. Case in point, me! Not too long ago I broke my left arm and post surgery was told to let it rest in a sling for 3 weeks before starting anything other than some simple motion therapy they had outlined. My wife and I went on a trip and I convinced her I could drive part of the way without straining anything.
The day after we got back I woke with tightness in my chest, shortness of breath and pain in my left arm. After heart and blood clot issues were ruled out we decided that I had actually strained my chest muscles driving. Caused a lot of cardiac symptoms but fortunately not any issues.
Others are not so fortunate. I had plenty of life insurance and no immediate need for it. We’ve lost a few people in our community lately for which the opposite is true, an immediate need and no life insurance.
Whether it’s shoveling snow or hunting or cutting wood, or just doing the list of honey-do’s that you’ve been putting off for a long time, putting a strain on an under exercised body is a prescription for disaster.
What about life insurance for those who survive heart attacks? Count on it being more expensive than before, but generally a year out from the event and a good stress test will get you back in the game. Factors like your age at the time of the event and how many vessels were involved will play in to how good the rates can be, but with the help of a knowledgeable independent agent, you should be able to get on the road back to cardiac and life insurance health.
Bottom line. Take care of yourself. Let prudence guide your life. Don’t be like me and you’ll get better life insurance rates.
November 2nd, 2009
Sometimes when I ask the medical questions that are part of the first interview with prospective life insurance clients I get the feeling that I should have gone through them twice, or three times.
Each time I should say something like, “Now when I go through the questions this time I want you to carefully think about each one, reflecting on whether your answer represents the medical facts or just your opinion. What I need are the facts”.
Really. When I ask “Have you ever been diagnosed with or treated for chest pain, high blood pressure, heart murmur, heart attack, stroke, cholesterol or any disorder of the heart or circulatory system”, how can a person answer no when they have had mitral valve prolapse all of their adult life? I know in the whole scheme of cardiac issues it certainly isn’t a big one, but they know they have it and even if they don’t equate it to a heart murmur (which they probably should), it has to fall into the catch all at the end asking about ANY disorder of the heart.
So, in this case the difference between a yes and a no answer to the question is the difference between preferred and standard rates. In many cases that is enough for a client to get in a huff and decide they don’t want the policy after all or that they are going to find some agent who can figure out some way for them to get the best rates even though they don’t qualify. And it’s all about being honest to a fault when answering health questions. I wonder if it would change if they had to answer the questions under some kind of oath?
Bottom line. Do yourself and your life insurance agent a favor and just answer the questions honestly. If you’re not sure if your answer should be yes or no, explain the situation to the agent and at least give them a chance to include the information in their thinking, or if it really isn’t important, to throw it out.
October 15th, 2009
Abnormal ekg’s make up a significant percentage of of the reason for postpones and declines on life insurance applications. Often it’s news to the applicant and just as often it’s something that their doctor may have told them about a long time ago and told them it wasn’t anything to worry about. After all, “It’s not like I had a heart attack or something”.
A critical thing to keep in mind is that how two companies handle an abnormal ekg can be as different as night and day. On plenty of occasions I have shopped “abnormals” that led to a decline with one company and was able to get it approved standard and occasionally better with another company. Certainly on more than one occasion we have been able to disprove the abnormality when a client is willing to get an independent ekg from their own doctor. While a person would hope that all ekg’s are created equal, an ekg done in a doctor’s office, generally a 12 lead ekg is often more reliable and different than a 6 lead ekg done by a paramedical person while you’re lying on your living room floor.
So, is your doctor wrong when they know you have an abnormality but they tell you it’s nothing to worry about? The truth is they’re probably right on the money because they know you, your health history, your lifestyle and if the abnormality is fairly benign, whether it has changed over the years.
So, is the underwriter wrong? Probably not based on the information they have and their company’s underwriting philosophy. He is probably following the guidelines. Therein lies the rub in this situation. Both are doing their job correctly but they seem to have adversarial opinions. The real truth is that the opinions aren’t adversarial because they’re not offering an opinion on the same thing. One opinion is about you alone and how you’re doing and the other opinion is about you pooled together with say, all the other people who have a right bundle branch block and what their overall mortality experience is compared to people without that abnormality.
Bottom line. Since you will likely never get the two sides to see eye to eye on the subject, when faced with an abnormal ekg, armed with a copy from the insurance exam and preferably an second go round with your own doctor, enlist an independent agent who can shop as many companies as it takes to get a rate that works for you.
September 24th, 2009
It’s amazing how a heart attack or a visit to the ER with chest pain can make you consider mortality. Even when you come away with a quick fix like a stent, life just seems a bit more fragile. So how do life insurance underwriters view cardiac issues? Can you get approved after someone has tuned up your ticker?
Several years ago I had a call from a man that explained that he had recently had a two vessel angioplasty and was wondering if he could get life insurance. I explained that in a lot of cases life insurance is very attainable after a cardiac procedure, but I needed a bit more information. I asked him where he was calling from, meaning with my question what state. He said he was calling from the hospital. I asked him how long ago he had the stents placed and he told me two days earlier. This guy had a sudden understanding of mortality and wanted to get protection in place right away.
I explained to him that in most cases we were looking at a year out from the angioplasty and a stress test showing good results, most importantly a strong ejection fraction which is an indicator of how much, if any, heart damage was done. We weren’t able to help him that day, but a year later he became a customer.
So, what does an underwriter want to see for optimal results in applying for life insurance after a cardiac event? First is some time. A year out from the treatment is pretty standard unless you are willing to take a big hit on rates. A few companies will consider prior to one year but they charge according to their perceived risk in stepping up early. The stress test is critical. Most cardiologists are going to have you do a stress test 6 months or so after the procedure just to see how well the repair is doing. Some wait as much as a year.
The primary indicator from the stress test that underwriters look for is the LVEF, left ventricular ejection fraction, a measure of how efficiently your heart pushes blood out of the left ventricle. Normal is in the 65% to 70% range for a person with no heart damage. Very few companies will consider coverage if a person’s LVEF is under 50%.
Other factors that they look at would be your age when the event happened. Prior to age 50 is problematic. Truth is that heart attacks at that age are out of the ordinary and indicative of aggressive heart problems. The possibility of recurrence is high. Prior to age 40 is going to be hard to find any takers at all.
Changes in life style play into underwriting. With obesity being a major risk factor for heart disease, a patient who aggressively undertakes a diet and exercise regime aimed at taking weight out of the equation will get more favorable consideration.
Cardiac rehab is something that is good to do and underwriters recognize that. What they are looking at is who is taking the issue seriously after the emergency has passed.
Bottom line. After a cardiac event you will not see preferred plus rates again, but if you do all of the right things and the damage was minimal, affordable life insurance is certainly a possibility.
July 18th, 2009
Life insurance is, always has been and always will be, about offsetting those financial losses that come with premature death. The problem that most people have with the concept is, that in spite of all of the evidence to the contrary, they seem to have a hard time believing that premature death is an issue.
Well, today we’ve all been witness to people that we knew, maybe not personally, but nevertheless, people we knew dying far too young.
We woke this morning to news that Farrah Fawcett had succumbed to long battle with cancer. At age 62, just 6 years old than me, she died. Women are supposed to live to 79 these days. She wasn’t supposed to die.
And then just minutes ago we found out that Michael Jackson passed away at age 50 apparently from a heart attack. There are plenty of opinions about how Michael Jackson lived his life, but there’s no turning your face away from the fact that three children just lost their 50 year old Dad.
Bottom line. There are plenty of days for being in denial about mortality. This wouldn’t be one of them.
June 25th, 2009
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
There are plenty of people that apply for life insurance and are sure they are going to get the best rate class available. In their mind they are even ahead of Superman because he has that disorder that has to do with Kryptonite. These people have never been sick, only see a doctor when their spouse makes them get a checkup, and have parents that are well on their way to living to age 115.
You know how sometimes you are just driving down the road and out of nowhere you hit a pothole? Before long even people in California will know what I’m talking about when the budget cuts get to the highway department. It shakes your world, your teeth and occasionally ruins your tire. It’s a bad experience.
A pothole in the life insurance application process would be something showing up on your exam or in your labs that bumps you a rate class, or two, or three….something you had no idea about and never saw coming. These things generally come out of nowhere (referring back to the first paragraph) because you believe that you are immortal and have never truly been checked out by a doctor.
One that bites a lot of applicants is cholesterol. Quick now! What was your last cholesterol reading? Your HDL? LDL? Mine were 164, 45 and 104. It’s a trick question in that the only way you would know the answer is if you had been to a doctor or a health fair and had lab work done. If you did that and had a problem then there’s a good chance you wouldn’t be finding out about your out of normal range lipids on a life insurance exam when it isn’t just a matter to discuss with your spouse or doctor, but a determining factor in what rate class an underwriter will approve you at.
So, how to avoid that cholesterol surprise on your exam? There are health fairs everywhere and the good news is that they are cheap and easy. I know this is a stretch for guys, but suck it up once a year and go donate a little blood and get checked out. Better to find out your cholesterol is creeping up on you that way than having the ER doc explain the relationship between cholesterol and blocked arteries.
If your cholesterol is stepping out of the normal range, diet and exercise might just be the cure. Even if you have to medically control your cholesterol most insurance companies still allow their best rate class. So, annually guys! And annually isn’t once every decade. That would be decadually. Once a year. Your wife will love you for it. Your kids will see a good example when you do it. You’ll get better life insurance rates. You’ll feel better and your friends will be impressed.
The other pothole is blood pressure. I had high blood pressure once, actually just one time due to some medication I was on. When my blood pressure when from my normal 110/65 to 145/95, I felt it and it didn’t feel good. In fact it felt so wrong that I have been convinced since then that high blood pressure is bad for you.
Quick! What was you last blood pressure reading? If you don’t know this one you really need to get out more. There are blood pressure machines in every Walmart and in most pharmacies and grocery stores. And they are free!!! If you find out your blood pressure is running higher than it should (they have little charts right on the machines), again, diet and exercise might do the trick. If not, again, there are more and more companies that want to see you doing the right thing and will approve you at their best rate class even if you are medically treated for hypertension. That’s a much better bet for them than taking their chances with heart attacks or a stroke.
Bottom line. There are plenty of folks out there that can just la la their way into the best rate class, but if you aren’t sure how that exam and labs will turn out it’s time for a preventive checkup. Your Mom would be proud of you.
May 14th, 2009
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