Posts filed under 'heart attack'
I think on some level we all carry a bit of denial along with us. It’s probably a chomosomal kind of thing, like there are x, y, z and denial chromosomes.
Unfortunately for those most affected by denail there is bad news from life insurance underwriters. Probably the best example of this is the underwriting treatment of those who really don’t believe the link between smoking and heart disease. There is probably nothing that is more likely to lead to a highly rated policy or with most companies, a decline, than someone who continues to smoke after they have had coronary issues.
Literally the best case would be if someone had a one vessel angioplasty with no heart attack and a great followup history of stress tests, complicated only by the fact that they still smoke. In the absence of smoking a case like this could get as good as a standard rate, with the norm being a lightly rated approval. Add in smoking and most companies will decline it. Those that do approve it will approve it at highly rated prices.
Why the big underwriting slap in the face? Well, the beginning and the end of the argument go like this. Smoking is the <a href=”http://www.mamashealth.com/Heart_stat.asp“>leading cause and accelerator</a> of heart disease! Why should life insurance underwriters cut you a break when you are knowingly doing yourself damage? You don’t really have to answer that because the answer is that they won’t.
So, what should you do if you have had cardiac issues and smoke and want life insurance. I recommend you apply and if you get approved, put as much in force as you can comfortably budget, then quit with the denial stuff and quit smoking. When you are 12 months out from the last nicotine entering your body, reapply and watch your rates be cut dramatically to something around 1/3 of what you were paying before. “Well, why not”, the denialist asks, “just quit smoking and wait a year and then I won’t have to pay higher prices for that period?”
Bottom line. Once you learn denial it’s a hard thing to shake. The reason you don’t wait a year is because you will feel so stupid leaving your family behind with no life insurance. Do what you can now and do more after you’ve corrected your bad habits.
January 3rd, 2009
Today would be no exception to my rule that men really don’t see a world that has consequences until they are old enough that they see the consequences happening to others their own age, or even to themselves.
I spent part of yesterday evening in the emergency room with my nephew who had finally conceded that three hours worth of rapid heart beat (85-110) and high blood pressure (160/110 as measured at Walmart) was reason enough to see a professional. He is 38 years old and by his own admission, inactive and at 6′3, 250, overweight.
I cut him some slack last night, but today let’s discuss his experience. His self admission of being overweight was actually cutting himself some slack. He knows about body mass index (BMI) as well as I do and he knows that his build puts him solidly in the obesity category. “Overweight” is a way many of us use to gloss over the fact that obesity carries with it a number of potential health issues, only one of which became all to real to him last night.
As we waited for lab results and talked, he admitted that he hadn’t been to a doctor in three years. This is a guy who reads my blog and knows my opinion of guys (yes, including me) and their stupidity about their own health. He confessed that his real concern with the labs that were being worked on was that he would be found to have type 2 diabetes, one of the risks of obesity, a risk he knows about all too well because he is also a life insurance agent who works with diabetics frequently. He admitted that he has had concerns about his blood pressure because of his lifestyle. All that is to say that he was aware that he was probably due for some health problems.
My nephew was no different than my average client laying in the emergency room last night. He knew he has been heading down the wrong road for a while. He knew that, at some point, his lack of attention to his health could hurt him or kill him, yet he did very little to change that direction. He bought a bike that he doesn’t ride. He doesn’t like to walk, so he doesn’t. The only thing last night that set him apart from the average guy is that he went to the ER knowing that he has an adequate amount of life insurance in force.
So, why regular checkups? For my nephew, one good reason would be that he would be hearing from a professional that he was treading on thin ice with obesity, a recipe for disaster. For all of us it could well give us that advantage of an early diagnosis of something that can be serious left undetected. If we flip through life with our immortality shield up, never getting checkups, a heart attack could be how you find out you have heart disease or diabetes. A stroke could be the way we find out about hypertension, the silent killer. Regular checkups are wake up calls that don’t hurt.
Bottom line. Prayers were answered last night and my nephew, with a fresh look at life, should be fine. We should all work harder at being proactive about our health. There are people that would miss us.
December 14th, 2008
Being in the life insurance business and having been on the business end of passing on checks for death benefits, I have a real sense of just how much life insurance is needed by the families that receive it and a real passion for helping others understand that buying life insurance isn’t about expense, it’s about peace of mind.
In the years that I have been posting this blog, the world according to Ed, I’ve been a bit rough on men. Maybe not rough enough though. Men have this real thing about life insurance. They seem to think it’s all about them and the money that they will have to spend to ensure that, even if they don’t, their spouse will make it to retirement financially OK. They think it’s betting against themselves. They think they would be better off just putting that money in investments so that they can enjoy it, never considering that there are significant odds against them seeing retirement.
When I say significant, let’s put that into betting context. I know people who buy multiple lottery tickets every month with a 1 in a bazillion chance of winning, or those who buy scratch tickets every payday with a 1 in 250,000 chance of winning anything other than the money you’ve blown through the years on all the losing ticket. So, what are the chances that life insurance will be needed between young adulthood and your mid sixties, what we used to fondly think of as retirement time.
Well guys, if you knew that those fairly small life insurance premiums were covering a 1 in 6 chance would it become something worth thinking about? 1 in 6 men who make it to 25 in our country don’t make it to 64. For women it is 1 in 9. That isn’t betting against yourself but rather doing the prudent thing to cover a very real risk for those who are dependent on you.
And the cost! I know everyone is rethinking how they spend money these days. Is there any chance that we have an inordinate amount of our income going to play and toys? Is it possible that with just a little creative thinking we could divert a bit of that play money to peace of mind money?
Bottom line. All of us know someone who has died far too young in a car accident. You are in a serious minority if you don’t have a family member who has died prematurely from cancer or a heart attack. And consider all those around you for who obesity is an ingrained part of life and that with that lifestyle comes the risk of diabetes and so much more. What part of life insurance doesn’t make sense?
November 19th, 2008
There isn’t any question that given the clear choice between suffering a potentially fatal heart attack and having the artery opening procedure called angioplasty, the prudent thing to do is to stack the deck in your favor and open those arteries.
But there is a serious question about the use of angioplasty as a preventive measure. In other words, if you are not in imminent danger of a heart attack and arteries that have begun to clog are treatable with medicine, is the risk of an invasive procedure still prudent and reasonable. Recent studies have shown that there appears to be enough inappropriate recommendations for the procedure that the American Heart Association and others will be releasing new guidelines within a few months regarding when an angioplasty should be set aside for treatment through cholesterol lowering and clot busting drugs combined with exercise.
Medically this is a huge issue. From a life insurance standpoint it can make the difference after the diagnosis of how soon a person can get life insurance and how much they will pay. If a person is found to have blockage that is successfully treated medically and those results can be substantiated on a subsequent stress test they could be looking at standard rates, possibly better, within six months. If they have an angioplasty, whether it was needed or not, it will be at least a year and a good stress test and then the rates will generally be higher than standard rates.
The good news is that, given a good stress test, either way you would be insurable. The bad news is that an over zealous doctor might do more damage than just handing you a large cardiologist’s bill.
Bottom line. Second opinion, second opinion, second opinion……unless you are having a heart attack.
November 17th, 2008
As soon as you tell someone that they don’t qualify for the best rates available, stand back, because the knee jerk reaction is to unload on you with something akin to the intelligent response, “So, they think I’m about to die of a heart attack, or what?”
First, let’s get a grip. If an insurance company thinks you are about to die they most assuredly aren’t going to offer any coverage at all, and they will probably have your agent contact you and suggest that you see your doctor sooner rather than later. I think every agent who’s been around for a while has run into a client, or a several, who has lab results come back that need immediate attention.
Just to recall a few I had a client who’s PSA on his labs was 35 and yes he did have prostate cancer but didn’t know it until it was suggested he see his doctor. I’ve had plenty of clients whose blood pressure was in the ridiculous range and they didn’t know they had a problem until we did an exam. By the way, a common theme here is that these people generally don’t get regular physicals. Another client was profoundly diabetic with an hbA1c of 11.9. After a year of treatment his diabetes was controlled enough to get the life insurance he wanted.
Mortality risk is the measure that insurance companies use to determine what rate class to approve you in, but if you don’t fall into the best mortality risk rate class it doesn’t mean that you should be saying adios to your loved ones.
Everyone is in love with the best rates available. I have long since fallen from that lofty level of health from an underwriting standpoint even though my doctor would swear to you that I’m in great shape for someone my age. All it took to bump me from preferred plus rates down to standard plus or standard was a silly thing called Raynauds. Raynauds by itself is not really a mortality issue but rather more of a pain in the rear issue. It causes my fingers and toes to change color and lose circulation when I get cold, or even just cool.
From an underwriting standpoint I have been told that Raynauds in and of itself is not a big issue except that it can be the first symptom of a larger and more deadly issue, CREST syndrome. I have addressed the issue with underwriters to the best of my ability and have not been able to convince them that while Raynauds can in fact be the first symptom of CREST, it generally doesn’t remain the first symptom for 25+ years.
Bottom line. Life insurance underwriting can’t be compared to medical evaluation. Underwriters and doctors and like men and women. They may both be good at what they do, but for the life of them they can’t figure out why the other one can’t see it their way.
November 11th, 2008
A study released this week by Astra Zeneca, makers of the cholesterol lowering drug, Crestor has turned a few heads in both the pro and the con aisle.
In a nutshell the study claims that the use of Crestor, or more generically statins, can decrease the risk of heart attack even in people who don’t have elevated cholesterol. It is their assertion that while cholesterol is a widely recognized culprit in artery clogging and heart disease, another culprit in the form of C-reactive protein should be, or should be according to them, an area of concern.
So, the question for me is, are life insurance companies unfairly weighting the underwriting against cholesterol and not against CRP? After all, according to the study half of all heart attacks happen to people whose cholesterol is in the normal to low range. So, are life insurance companies whacking people with borderline high cholesterol while rewarding low cholesterol that may be accompanied by elevated CRP? At this point, since CRP is not part of a standard blood workup on a life insurance application it seems the answer would have to be yes.
On the pro side of this finding it is being hailed as a breakthrough that could stop as many as 50,000 heart attacks annually. On the con side it is being assailed as another way to over medicate preventively. From a life insurance standpoint there is always a chance that CRP testing will become standard and we will have to deal with the ambiguity of cholesterol vs CRP. How will they decide if you are a mortality risk? Will they penalize people for not being on statins even though there isn’t any clinical reason to be taking them?
Bottom line. The good news from a life insurance underwriting standpoint is that underwriters aren’t likely to be as quick as Astra Zeneca to jump on these results as mortality significant. They’re a methodical lot when it comes to change.
November 11th, 2008
They’re the rates you see advertised all the time and they are definitely the rates that everyone would like to be paying for their life insurance coverage. But do you qualify?
First let’s dispel with a few old myths. Your age and the amount of insurance have nothing at all to do with whether you qualify for the best rate class. Being younger doesn’t make you better qualified and asking for more insurance doesn’t mean you are less likely to be approved for the best rates. What matters is your health history, your family history and your lifestyle.
Build matters. Every company has a build chart. 5′5″ and 160 pounds gets the best rates, 190 pounds doesn’t. 5′10″ and 190 pounds gets the best rates, 210 pounds doesn’t. Life insurance companies are more lenient than the standard BMI charts, but they are there and underwriters are serious about them. They know there is a link between obesity and any number of health issues with high mortality experience such as diabetes, heart disease or cancer.
Your lab results, both blood and urine have to be in the normal range. If you haven’t been to a health fair or had a physical with blood and urine profiles, you may be in for a surprise when you apply for life insurance. It is fairly common for people to discover their perceived perfection is flawed when they are faced with the reality of lab results. Cholesterol, liver functions and glucose (blood sugar) are just a few that pop up and surprise people.
Your family history matters. If you had a parent die before age 60 of a heart attack or stroke, underwriters aren’t going to lend a sympathetic ear to your tales of your parent’s lifestyle. They will look you straight in the face and tell you that in spite of the fact that your father weighed 400 pounds and smoked and drank and never exercised, they don’t have any proof that he wasn’t predisposed genetically to heart disease.
They will look at your driving record. They will ask about any past drug or alcohol treatment. They’ll ask about your hobbies and they, not you, gets to decide if it’s risky. They’ll ask about foreign travel and again, they decide if what you do is risky.
Bottom line. The best rates in life insurance are worth shooting for, but before you get your heart set on them you might want to have a serious talk with an independent agent and see if you are really going to stack up.
November 10th, 2008
For as long as there has been life insurance and heart attacks there has been misinformation about the impact of the event on future ability to obtain the insurance.
Two of the most common myths are that 1. If you’ve had a heart attack then you are simply toast and will not be able to get life insurance and 2. There is a five year waiting period after you’ve had a heart attack before you can apply for life insurance. If this was a multiple choice test the answer would be 3. none of the above.
With heart disease testing and detection improving all the time and with post heart attack treatment doing the same, the chances of having a heart attack and the actual damage from any heart attack have greatly diminished. New testing helps detect blockage early enough that often cholesterol lowering and clot prevention drugs keep patients from having any procedures at all. If blockage has reached a point where there is potential for damage, state of the art angioplasty or bypass surgery can be performed.
If blockage is caught early enough to treat with medication there is a good chance that, given no other risk factors, rates can be as good as preferred or preferred plus soon after treatment has started and a positive stress test has shown that the treatment is working.
If there is an angioplasty or bypass surgery with no heart attack, insurance can be applied for as soon as 6 months to a year after the procedure, again, as long as there has been a stress test completed that can address the current condition of the heart and any arterial blockage. The rates that can be approved will depend on an applicant’s age. Like diabetes, age of onset is a real hang up with underwriters. Anything prior to age 50 will incur a higher rate than post 50 and prior to 40 will be rated even higher.
If there has been a heart attack followed by angioplasty or bypass surgery, the same 6 months to a year and a good stress test applies, but you can assume the rate will be higher simply because a heart attack causes heart muscle damage that is often not reversible.
Bottom line. Heart issues don’t deal a death blow in most life insurance situations. It may make it a little harder work for your agent and you, but in most cases realistically priced insurance should be available through a knowledgeable independent agent.
October 31st, 2008
But declines happen. I’ve put together a list of the top reasons that applicants are denied coverage. We’ll start out with the first two which were covered in a post yesterday.
1. Your agent did a sloppy job. Sometimes agents slip into a habit of not wanting to ask the hard questions about your health. They just want to make you feel good, get the application and hope for the best. DECLINE!
2. You kind of don’t tell your agent the whole truth about your health, or maybe you just flat out lie in the hopes that somehow the insurance company won’t really underwrite your application. They usually do though. DECLINE!
Then there are those reasons for decline that aren’t attributable to you or me.
3. Your doctor has poo pahed some health issue and told you that, for instance, you have the heart of a 30 year old in spite of your heart attack. Doctors are famous for telling people how great they’re doing with no factual medical basis to back that up. I had a client once who was told that he was in great shape after his heart attack in spite of the fact that his ejection fraction was 25%. In layman’s terms, his heart really wasn’t pumping but rather just kind of easing the blood on down the road. Bad doctor education. DECLINE!
4. Unexpected lab results are a major reason for unexpected declines. Over the years it is amazing the number of clients we have sent off to the doctor with a declined life insurance application and a copy of their labs. Generally it shows that something has changed dramatically since the doctor last did tests, like a PSA that has elevated or it shows that maybe you should have been seeing a doctor occasionally or your cholesterol wouldn’t be in the 400 range. DECLINE!
5. Non compliance with doctor recommendations is a big one. If your doctor tells you he thinks you should have a cardiac workup and you don’t do it, no matter the reason, it won’t fly with insurance underwriters. If your doctor prescribes medication and you, not your doctor, decide that it isn’t doing what you want so you quit, again you’re grounded. If you’re not liking what your doctor tells you to do and you want life insurance, you had better find a new doctor that agrees with you or comply with your current doctor. Non compliance. DECLINE!
Bottom line. Getting approved for life insurance is a lot easier than getting declined. Think it through before you apply
October 30th, 2008
You don’t buy life insurance, rather, you apply for it. Because there is an application there should be a common understanding that there is a chance that your application will be rejected. The industry term is decline.
While declines are far more the exception than the rule, there are some common threads found in declines. These same threads are often found in applications that are asking for preferred rates and come back at standard or higher rate approvals.
I know. You’re used to me eating the face off of clients for their lack of knowledge or lack of candor when it comes to their medical history, but today we start with the insurance professional, the agent. In most cases a knowledgeable independent agent will know enough after an initial interview with you to know if you will be approved and within a reasonable margin of error (not politics, lab results), they should be able to quote you the rate class you will be approved at.
In the cases where there are health issues a prudent agent will take all the information and send it out for trial offers from underwriters. Expect a good agent to dig for as much information as they can get because insufficient information will lead to an inaccurate quote and an unsatisfactory outcome. I have had people tell me that I ask too many questions or even tell me “that I don’t need to know that, just quote me”, but trust me, you want an agent who knows what questions to ask to get to the underwriting bottom line.
Let’s say you have diabetes. I can ask you what your most recent hbA1c is up front and if you don’t know it, insist that you call the doctor’s office and find out what it is or, I can quote you a best case scenario and when your hbA1c comes back high in your medical records we can have a friendly chat about why the cost of your insurance just doubled over what I quoted. Or I could call you to explain that you were declined. Some wise guy once said “knowledge is power” and when it comes to successfully coming through with good life insurance rates in the face of health issues, it most certainly is true.
The agent has a professional obligation to be a fact finding animal. It’s the best way to serve clients. Clients, if they want the best possible service, have an obligation to be accurate and forthcoming to the max. Don’t ask, don’t tell, is not the relationship that wins in insurance underwriting. A recent example would be a client who answered no to chronic respiratory disease because I didn’t ask them about reactive airway disease. Get real!
Truth is that even if I ask someone to disclose everything that has ever been a health issue, in their mind a heart attack might not be a health issue because they lived through it and after the five vessel angioplasty their doctor said they are just fine. Would you take your car into a mechanic because it’s running really bad and just neglect to tell them that because of the price of gas you tried watering that $3 a gallon stuff down a bit?
Bottom line. Garbage in, garbage out! If the agent doesn’t do their job the end result isn’t what you expected and conversely, if you aren’t completely forthcoming with the agent, don’t expect them to pull off a miracle for you.
October 29th, 2008
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