Posts filed under 'heart disease'
I think I’ve been very clear over the years about unexplained information in medical records and how life insurance underwriters deal with it. They ask questions!
Sometimes the mystery information isn’t relevant once it is explained. Sometimes the information doesn’t even pertain to the patient. I think I’ve shared this before, but several years ago a client was declined after a review of medical records due to not admitting a history of heart disease.
After calling the client with the news, she was adamant that she had never had any kind of cardiac event and had never consulted a doctor for any potentially cardiac related symptoms. After speaking to the underwriter, he said that the records clearly mentioned the word angioplasty. He gave me the page number and said the word was circled. I passed this on to the client who pursued a review of her medical records. She and her doctor were finally able to nail down the reason for the note. It seems she had a friend who was going to undergo an angioplasty and she had asked the doctor to explain what it was. As he explained, he doodled and subsequently left the word angioplasty in the records of someone who didn’t even know what it was.
Doctors are notorious for doodling or writing down some thought with no further explanation. And generally I become the messenger, being shot on sight because the underwriter is asking for clarification. It means homework for the potential insured and while some don’t mind, most feel as though they are being asked to do the work that someone else should do.
This came to a head with one client the other day when I called and asked if she could get a letter from her doctor explaining why he had circled a certain condition on two separate visits, something not done on any other visits. Without clarification the company was willing to offer coverage at a higher rate than originally quoted. With an explanation we could likely have had a policy issued at the same rates originally quoted. She refused. She said it was obvious to her and if it wasn’t obvious to the insurance company, then they were just trying to gouge her for additional premium. The circled condition with no explanation needed clarification. She shot the messenger and withdrew her application.
Bottom line. Underwriters have to try to make sense of your medical records. If you think that’s easy, you’ve either never been sick or never looked in your medical records. If an agent comes back to you asking for clarification, it’s not because the insurance company wants to raise the premium, but rather because they are looking for an explanation that would help them avoid that.
August 14th, 2008
As we’ve reviewed the underwriting criteria for life insurance when it involves diabetes over the years, I’ve beat the need to know your hbA1c to death. I would guess that more than 50% of diabetics I have spoken with don’t even know what I’m talking about, which in my mind heaps shame on their doctors for not educating their patients properly.
The hbA1c is a lab test that the doctor that is managing your diabetes will typically run every three months. This test is extremely relevant to them as it is the most accurate indicator of how your treatment is working. It tells them if you have achieved control and average glucose levels are low enough that no collateral issues should occur.
Life insurance underwriters are very interested in the same information. They take with a grain of salt what your fasting glucose level is. The proof comes when all the highs and lows are averaged. Control isn’t measured by your ability to fast and artificially lower your glucose, but rather by averaging those fasting periods with the more frequent real life periods when you aren’t minding the shop and your glucose rises.
Another relevant issue to underwriters when it comes to diabetes is the age of onset. Diabetes has potential impacts on other health issues such as heart disease and kidney health. The longer a person has diabetes, the greater the chances of complications and the greater possibility of a negative impact on mortality. From an underwriting standpoint, onset prior to age 40 is substantially different than after age 50.
Also important to underwriters are those health issues that, in combination with diabetes, make it harder for a person to avoid complications. Probably the two most important are obesity and high blood pressure. With obesity being one of the primary causes on diabetes onset, trying to control diabetes with unchecked obesity is problematic at best.
The good news is that for many with onset after age 50 and well controlled diabetes, standard or better rates are available.
Bottom line. Make sure you educate yourself on what diabetes means in your life. Don’t expect that your doctor will provide answers to questions you don’t ask. Seek out a knowledgeable independent agent to help you seek out the best rates and be ahead of the curve when you do by having your most recent set of labs available.
July 30th, 2008
I’ve mentioned many times that the large internet agencies are well equipped to pursue and sell the younger age, completely healthy market. It is, for them, an uncomplicated and easy way to keep the cash flowing.
It is much quicker and easier than dealing with older clients that have health issues or for that matter, any age client with serious health, physical or mental, concerns.
We have been very successful by focusing on just the opposite market of the larger internet agencies. We specialize in finding and placing the best possible rates for people with issues ranging from bipolar disorder to heart disease to diabetes and epilepsy. In writing about these specific topics before I have often noted that if you have one of these issues and are looking for the best possible rates, you need to find an independent agent and avoid both the large internet agencies and agencies that specialize in auto and homeowners insurance.
Simply put, the large agencies don’t want to invest the time it takes to find you the best rates. You local Farmer’s Insurance agent doesn’t have the products or the underwriting power to get the job done for you.
Bottom line. If you are in less than perfect health, your time and effort is best spent talking with independent agents who understand your health issues and know what companies to go to and which to avoid.
July 28th, 2008
We’ve blogged long and hard for years about the obesity epidemic in our country and the high cost the participants are paying in added health problems, shorter life spans and higher life insurance premiums. So, not that we had anything to do with it, but hats off to those New York restaurants that are now posting calories along with price on their menus.
Our country has worked long and hard figuring out how to market fat and calories under cute names and making quick and easy a dietary choice that seems to have sucked the common sense out of our nation’s health consciousness. That is not to say that there weren’t poor choices to be made 40 or 50 years ago, but with today’s marketing machines in full gear, fit as a fiddle may have to be updated to a cello.
So what’s the big deal about obesity? Clearly, with a few exceptions, it’s a lifestyle choice that’s been made and you make your bed and lie in it, right? If obesity was the end result, from a life insurance perspective it wouldn’t be such a tough hit. Weight alone will keep you away from the best rates, but it still leaves you affordably insurable.
The problem is that the weight, the obesity, is the start of an almost certain downhill health slide and studies seem to indicate that unchecked obesity doesn’t leave you in a place where you wonder if you’ll have health problems, but rather how bad will they be.
Bottom line. If you’re tipping the scales in the wrong direction, you may want to consider purchasing adequate life insurance before the health problems start happening. Once you come face to face with diabetes, heart disease or cancer, the task becomes much harder.
July 21st, 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
To a guy this makes perfect sense. From my own experience I can tell you that most women, especially those married to guys that feel fine, don’t share that philosophy. Unlike us guys, they think doctors are serious about the importance of annual physicals and things like colonoscopies after age 50.
Well gentlemen, life insurance underwriters are from the same planet as our wives. Most companies, even though they do a full blood and urine analysis as part of the application process, will postpone an approval if you are over age 50 and haven’t seen a doctor in the last two years. There are a handful of companies that will hang in there and allow you to get by on your own medical advice up to age 60, and only one that I know of that will go to 65.
Let’s get real for a minute. We all (every one of us) knows someone who died too young and felt fine right up to the time they had a heart attack, or felt fine right up to the time they were diagnosed with colon cancer. Heart disease and colon cancer are a couple of good examples of the kinds of things that can be discovered early enough to save your life if you follow the standard doctor recommendations. It simply doesn’t take that much time or money to keep track of your health.
I had a potential client recently who refused to have a life insurance exam because “people find out bad things when they have exams”. So I explained guaranteed issue life insurance and that was more than she wanted to pay (yes guys, I said she). She wanted the best rate but didn’t want the insurance company to have a clue what her health was and even worse, she didn’t want to know what her health was. How stupid is that?
I’ve touched before on how underwriters feel about not following doctor’s orders. If a doctor has recommended that you have a test or a procedure and that hasn’t been done, expect your application for insurance to be postponed until you successfully define and do the word compliant. Maybe you’re not real keen on having a blood test or a colonoscopy or a digital rectal exam, but when your doctor orders it and hands you that slip to make arrangements to get it done, or simply asks you to drop your pants and bend over, it’s because he expects you will follow through. Underwriters have that same expectation.
Bottom line. The more you care about your health, the more likely you are to impress life insurance underwriters.
July 1st, 2008
A lot has been made over the years about diet and exercise being key components of a successful battle with hypertension or high blood pressure. But from the fringes we keep hearing snippets about drinking a glass of wine a day, eating dark chocolate and other things that seem oddly out of place.
Diet and dark chocolate! Diet and dark chocolate! Almost seems oxymoronic. I know from my experience that when I’m munching down dark chocolate, the word diet is secretly deleted from my brain during that moment. Maybe that is the power of antioxidants. Maybe they aren’t really good for you, they just erase guilt from your mind so, a little wine, a truffle….life is good.
But such is not the conclusion of studies that show that antioxidants actually do lower high blood pressure. This happens through a process of antioxidants inhibiting something called free radicals (sounds like something out of the 60’s).
This ability to inhibit free radicals can have far reaching effects, staving off high blood pressure which can prevent strokes and helping to prevent some of the big boys like heart disease and cancer.
So, will you get lower life insurance rates if you explain on your application that you eat blueberries or dark chocolate or (yum), dark chocolate covered blueberries from Harry and Davids, daily? Well, not from the mere mention of the fact you won’t, but a healthier you is a better life insurance risk and that should lead to lower rates.
Bottom line. Do what your mom told you. Eat chocolate and drink wine….and eat your vegetables. Science is on her side.
June 24th, 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
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
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