Posts filed under 'high blood pressure'
Occasionally when I am doing an interview to determine what rate class a person will fall into and what company will be best for them, I am asked if they will look less critically at the health issues if they ask for a smaller amount.
This often comes as questions like, “What if I apply for two $250,000 policies with separate companies instead of $500,000 with one company?” The thinking, and it has some logic to it, is that if a company is exposed to less risk maybe they won’t look at the health history or another issue as critically. That could end up with this logic, rather than a large policy approved at a standard rate, two smaller policies might be approved at preferred rates.
Unfortunately for the life insurance shopper underwriting doesn’t work that way. The truth is that while a company may do more tests and more intensive scrutiny of medical records at higher amounts, if a person has elevated liver function, high cholesterol or problematic family history, the company will award the same rate class whether the face amount is $100,000 or $10,000,000. If that weren’t the case then everyone with health issues would be buying multiple small policies rather than the amount they need in one policy.
I mentioned that the underwriting requirements do get more stringent at higher amounts. Here is a standard table of requirements starting with A being children under 18 at lower face amounts to H, I, and J where the requirements are for older ages and high face amounts. Actually they aren’t in exact order as A, B and E are for applicants under age 18. Note that none of them require a full blood draw.
A Non-Medical
B Paramed, Urinalysis, Attending Physician Statement
C Paramed, Urinalysis, Blood Profile
D Paramed, Urinalysis, Blood Profile, EKG
E Paramed, Urinalysis, Attending Physician Statement, Dried Blood Spot
F Paramed, Urinalysis, Attending Physician Statement, Blood Profile, EKG
G Urinalysis, Blood Profile, EKG, Physician Exam
H Urinalysis, Attending Physician Statement, Blood Profile, Physician Exam, Treadmill EKG
I Urinalysis, Blood Profile, Physician Exam, Treadmill EKG
J Urinalysis, Attending Physician Statement, Blood Profile, Physician Exam
Bottom line. While the up front requirements may differ, the results are all measured the same. Again, high blood pressure is high blood pressure whether the applicant wants a modest amount of insurance or tens of millions.
August 25th, 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
For a long time in the medical and life insurance communities there has been a definition of when someone has diabetes as opposed to being pre-diabetic. The problem has been that doctors had clear courses of action they could take when confronted with a diagnosis of diabetes, but the whole idea of pre-diabetes has never been clearly defined and there has really never been any clear direction about what should be done about it.
Now the diabetes docs, the American Association of Clinical Endocrinologists, have come up with guidelines
for both diagnosing and treating pre-diabetes. This can have huge implications as virtually everyone is pre before they are, and in essence what they are talking about is a plan to keep more millions of people from being added to the type 2 diabetes epidemic.
The whole idea from the diabetes docs is that really anyone that sees a doctor on a regular basis should find out that diabetes is in their future in time to keep it from coming to fruition. Little (or big) clues like being treated for high blood pressure and having “a big waist circumference” (code for obesity). If a persons labs show too little HDL, bad cholesterol or triglycerides that are too high.
At that juncture, in combination with high, but not quite diabetic, glucose levels the docs agreed that it’s time to have a serious talk with patients. Most agreed that in the pre stage of things medical intervention in the form of diabetes medication should not be the first line of attack. This is the point where they need to talk serious lifestyle change and put the fear of full blown diabetes and all of the collateral health issues into the train of thought.
If you think about it, no one in their right mind that knows that they will become diabetic if they don’t make some changes is going to ignore the warning. I know there is a large membership in the You Just Can’t Fix Stupid Club, but most of those are guys and maybe the endocrinologists could at least save a large percentage of women from suffering what they don’t need to.
It will be interesting to see how life insurance companies will treat this situation. Up until now being pre diabetic wasn’t an issue because in their mind you either are or you aren’t. But if people’s medical records clearly show that they are being treated, even if it’s only lifestyle counseling and monitoring, I suspect some companies will reward pro activity with higher rates. One company, Banner, has already stated that they will still offer best rate classes to someone who is actively addressing pre-diabetes. That’s the kind of reaction we should see and a good independent agent will be able to seek out those companies for you.
Bottom line. With the epidemic of type 2 diabetes in our country growing more rampant by the day, it’s good to see a more proactive approach.
August 1st, 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
There aren’t many weeks that go by without hearing from someone who has finally figured out that they should have life insurance…..because their own mortality has been flashed before their eyes. This can come in the form of losing a friend or loved one or perhaps being in an accident and coming out with that thought in your head that, “Oh my God, I’m alive and probably shouldn’t be”.
Those are the easy ones to deal with. A wake up call with no harm done. But all too often the wake up call is because of some dramatic change in our health. People who have been diagnosed with cancer or who have had a heart attack tend to have a sudden, often fervent desire to look into the life insurance that they have been ignoring for years. They realize that they have blown the chance at getting good rates on the protection they now want and are desperately hoping that somehow this one health scare will be looked at by life insurance underwriters the way one speeding ticket would be looked at by an auto insurance company.
We all look for those second chances in life. Unfortunately, when it comes to the best rates that a life insurance company offers, with serious health issues there really are no second chances out there. If you are easily jolted into action by something minor like your cholesterol being a little too high, or with a few companies, your slightly high blood pressure needing a little medical nudge to get back to normal, you’re still in the running. Just about anything more serious than that will bump you at least one rate class, if not more.
So, and this is what all Americans really want to know, how do you beat the system? First and foremost you need to have a serious talk with yourself about your responsibilities and how, even though you are young and healthy, if something happens you will have failed to take care of those who depend on you. Second, you need to get over (we’ve all been here) that young, healthy feeling of immortality. You may live to be 120 and you may die tomorrow or be diagnosed with a terminal illness next month.
That’s the bad news. The good news is that for healthy people life insurance is probably the least expensive insurance you will have in your portfolio. Get it while you’re healthy. Get it while you’re still a good deal.
Having said all of that, should people with health issues give up on owning life insurance? No! It will cost more than your completely, disgustingly healthy cousin, but for almost everyone it is still available and with the help of a good independent agent, you can get the job done.
Bottom line. Life insurance is a good deal for family protection even when you don’t qualify for the best rates. Where else can $50 or $100 a month buy your family hundreds of thousands of dollars worth of peace of mind? Look into it today.
July 9th, 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
For just about any health issue there is a “sweet spot” for life insurance underwriting, that place where all of the pluses overcome the minuses and a better than usual approval is received. This is especially true of underwriting guidelines for type 2 diabetes and the good news is that with current treatment options it is possible to shoot for and reach the thresholds that bring lower insurance prices.
With diabetes underwriters are looking for those people who accept that they have it but aren’t willing to let it get a hold on their medical future. A lax attitude toward diabetes can lead to complications and collateral health issues, none of which paint a pretty picture for the years to come.
To start with, early onset type 2 diabetes is a problem. Most type 2 can be traced back to life style issues with obesity being the number one culprit. If a person, due to poor life style choices, has diabetes starting in their 20’s-40’s, convincing an underwriter that you present a good life insurance risk is going to be very hard. The first sweet spot in underwriting type 2 diabetes is onset after age 50 and not linked to morbid obesity.
The underwriters want to see compliance with your doctor. Do you take seriously your doctor’s recommendations to lose weight, exercise and change diet? Do you take your medications and check your glucose regularly? Have you done any diabetes education classes? Do you know what an hbA1c is and do you know what your’s is?
Underwriters want to see control. They don’t care if you can fast and get a glucose reading of 98. They want to see that you hbA1c is less than 6.5 which would indicate that your glucose levels have been consistently in a controlled range for the past three months.
And last, but by no means least, to get the best rates you can’t have other risk factors such as eye sight, high blood pressure, kidney problems or coronary artery disease (CAD).
Bottom line. The sweet spot for diabetes underwriting is all about late onset and good compliance, education and control.
June 16th, 2008
We all know about the link between high blood pressure and strokes and/or heart attacks. In my slightly unscientific mind it is something like blowing up a balloon a little too much a few too many times.
There is a thing called white coat syndrome, named such because of the white coats that most doctors used to wear when they would see you in their office (they’re much more casual now). Anyway, the result of white coat syndrome is that a person whose blood pressure is normally, if not always, in the normal range, will without fail have a spike in their blood pressure readings when they have their blood pressure taken at the doctor’s office.
Studies have shown that white coat syndrome has little or nothing to do with a conscious fear of going to the doctor, the doctor or nurse themselves, or the office. It is apparently some kind of subconscious reaction. But, conscious or subconscious, the result is spikes in blood pressure that, if they were the norm, would have to be treated as they are generally spikes to very high levels.
The dance I wonder about in all of this is, if a patient is determined to have white coat syndrome and not treatable hypertension, what if there are other things that subconsciously elevated their blood pressure also? Could it be blood pressure spikes are a fairly frequent occurrence and that the only place it is noted is at the doctor’s office? I wonder how a doctor can determine that, even though a patient tells them the readings at the local drug store or with a home monitor are normal, that readings if they were taken in a traffic jam or at the dentist’s office or during football games, aren’t elevated also.
If the visit to the doctor’s office is just the tip of the blood pressure iceberg, it seems that there is a real chance of people with chronic blood pressure spikes running around out there not getting the medical help they should. Call me a skeptic, but if something can trigger this subconsciously in a doctor’s office it seems that you’re talking about a fairly strong subconscious.
From a life insurance standpoint well controlled, treated high blood pressure is really not a big deal. Most companies will offered preferred, if not preferred plus rates. If you are applying for life insurance and have been told that you have white coat syndrome, tell your independent agent right up front. This gives your agent a chance to do a couple of things that may help you put the syndrome in context for the insurance company.
First, your agent can let the examiner know so they might take more than the normal three readings. Often successive readings will get lower. The examiner will also know to time a blood draw so that it doesn’t impact the blood pressure readings by creating a nervous situation. Second, the agent can let the company know about your diagnosis of white coat syndrome so that they are not surprised by readings in your medical records. And lastly, you should make sure that your doctor has, in fact, diagnosed white coat syndrome and noted it in your medical records. If it isn’t addressed in your medical records the insurance companies will not buy it as a defense for high blood pressure.
Bottom line. White coat syndrome has been a real diagnosis for a long time. Whether or not I completely buy into it, if it is well tested and documented, it can be used as an affirmative defense against otherwise damaging high blood pressure readings on an insurance exam or in your medical records.
Just a personally skeptical aside. If I was told I had white coat I believe I would asked to be tested across a broad spectrum of psychologically stressful situations. I would hate to go through life merrily believing I had some subconscious quirk that elevated my blood pressure only in one situation, only to find out when I suffer a stroke talking to a mortgage banker that the issue was more wide spread than was thought.
June 2nd, 2008
I was providing some information on the underwriting of bipolar disorder a few days ago on a bipolar forum when the question came up, “Why is bipolar disorder an issue with life insurance”.
Being in the life insurance business I am keenly aware that most people believe life insurance underwriting is an over reaction to whatever their particular ailment might be, from high blood pressure to cancer. I have shared more than once that I have that same reaction to the rates I pay. I understand why I pay the rates I do. I just happen not to agree with the logic that got them there.
I would like to address bipolar disorder straight on and answer that question. I have said many times that a person who admits to being bipolar is likely to be declined off hand, without any further study or thought on the part of the insurance underwriter. The reason, although I believe unfair, is the link between bipolar disorder and suicide. I have seen the argument raised in bipolar forums that suicide shouldn’t be an issue because insurance companies don’t have to pay for death due to suicide. There is where part of the rub lies. Insurance has to pay for death due to suicide after 2 years, 1 year in a few states. So, whether the suicide issue is valid or not, it is fair for insurance companies to consider.
With that in context, let’s look at the upside of all of this information. First, the majority of suicides that occur, happen during the early phases of diagnosis of bipolar, if not before the diagnosis. In general once a person is diagnosed and under treatment, stability begins to set in and, while life may never be completely normal, in many cases it is.
From a life insurance agent standpoint, my job becomes something like a door to door salesman. I sell something that people would probably really want, but the knee jerk reaction is to slam the door without even hearing about what I have to sell. With life insurance underwriters it is the same thing when shopping a case involving bipolar. I have to get them over the knee jerk reaction long enough to tell the story. When they hear that my client is a classic well controlled, stable member of the community who not only hasn’t attempted suicide, but certainly doesn’t intend to, the open the door a little further. When I explain that they are compliant with treatment and their only hospitalization for bipolar was when they were diagnosed, they invite me in and we discuss how we can work together to help the person get what they want while the insurance company gets exactly the same.
Bottom line. The answer to the question about why bipolar is an issue is that any health or mental impairment is an issue. I can’t escape that fact and unfortunately neither can my clients. What can be done is to minimize the impact that bipolar has on the outcome. If you use the right independent agent who uses the right companies, bipolar will get the same fair underwriting that anyone else would get.
May 26th, 2008
I went off a bit on some of the more ridiculous combinations with smoking the other day. Smoking and asthma. Smoking and heart disease, etc. Some guy (blog name Joe Camel (clever)), took some hard swings at the life insurance industry for being so mean to smokers. Fortunately for me smokers run out of breath quick and the hard swings turn to frail flailing.
So let me throw a little different spin on this subject and see if makes the point. 120,000 people a year die from COPD (chronic obstructive pulmonary disease), almost all of them smokers. COPD is the number four killer in the US behind heart disease, cancer and strokes.
The American Lung Association shared some interesting facts about the little talked about COPD.
It seems that COPD is another one of those silent killers, not unlike high blood pressure or hypertension. Often the symptoms are shrugged off as natural consequences of smoking or lifestyle. Things like smoker’s cough, or just feeling your age or feeling out of shape. The longer they are shrugged off, the more damage your lungs suffer.
Bottom line. Whether you agree with life insurance companies and their underwriting guidelines around smoking, do the right thing. My wife and I recently vacationed in Mexico and in the duty free shop at the airport they were selling huge boxes of cigarettes. I think each box must have held 10 cartons or something. On the top was the brand name of the cigarette and on the side, in huge letters that covered the whole side of the box, it said SMOKING KILLS! Sounds like someone down there understands the statistics.
May 22nd, 2008
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