Posts filed under 'high blood pressure'
In Job 12:11 it says “Does not the ear test words, as the palate tastes its food?” When a life insurance agent gives you a quote that you know sounds a little too good, do you question it or set yourself up for disappointment by choosing to believe something that, deep down, you really know isn’t accurate?
It’s OK to tell an agent to back up their quote with something from the company they are suggesting. Two things I share fairly often are copies of company underwriting guidelines and copies of underwriting trial quotes that show to a client that I’m not just throwing out low ball quotes in hopes of snaring their business. The quotes are based and formulated from facts and backed up by the company.
Let’s pick this apart a little. Say you have presented your health history to an agent and you are treated for high blood pressure. The agent quotes the best rate class with Savings Bank Life, one of the most competitive companies out there. The approval, if the blood pressure is well controlled, will actually come back at preferred, their second best rate.
Most customers I’ve talked to have heard or believe that high blood pressure treatment will affect their rate, so if you had questioned this agent up front, he or she would not have been able to back up the quote with either SBLI’s underwriting which states for their best rate class, “Blood Pressure: No treatment, past or present, 135/85 up to age 60, 145/90 age 61 and over”. They certainly would not have been able to produce a trial or quick quote from SBLI underwriting saying that blood pressure treatment is OK at their best rate because it clearly isn’t.
If you had been fortunate enough to have an independent agent who knew their underwriting they could have quoted Banner Life, “Blood Pressure: Currently well controlled with or without treatment, with no readings in the past two years greater than 136/86″, or Minnesota Life, “Blood Pressure: Must be better than 135/85 with or without treatment”. Both companies distinguish themselves in simple underwriting by offering their best rate class for treated blood pressure, where the competition is a full rate class behind, 20% to 30% higher.
If there is the chance of a 20% to 30% error on something as simple as blood pressure treatment, consider the chance for egregiously wrong quotes if an agent doesn’t consult with underwriters before quoting something like arrhythmia or type 1 diabetes.
But the point, and I should get back to it, is that you as a life insurance customer are completely justified in asking an agent to show you some kind of proof that, in the absence of some information neither of you knew about, they can come through with the rate they quoted. Really, we usually know if the rate we’re being quoted is just a little too good and while it might feel good to think we might get those rates, it feels bad when we don’t and especially bad when we find out that the agent should have known that to start with.
Bottom line. The proof in life insurance is in the approval, but before you commit to an agent or a company there is a couple of ways to get pre-proof. Test the words of the agent.
November 16th, 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
I am beginning to believe that our little mountain town here in one of the healthiest states according to several studies, is home to a bunch of closet cholesterol snarfers.
I know you don’t really snarf cholesterol, but I also know that if you do the typical male thing and ignore it, don’t get checkups and generally do the health la la walk through life, cholesterol has a way of being one of the first things to start sliding. Cholesterol is also one of those health issues that isn’t just an annoyance, but can actually reach out and bite you….to death.
I had talked just a few weeks ago about a local client who bragged about not having seen a doctor really ever in his adult life for anything preventive. He thought he might have seen one 9 or 10 years ago when a cut on his finger became infected. On his life insurance exam it turned out he had cholesterol by the bucket loads and HDL by the teaspoons, not a good combination.
He was all bluster about how cholesterol didn’t mean anything and insurance companies manufactured ways to raise peoples rates. His wife called a few days later and told me to issue the policy and that her husband was going to seeing a doctor about the cholesterol.
On the heels of that comes another local client with an almost identical medical history, none, and of course expecting that he would get preferred plus rates. After all, no doctor had ever told him he had any health problems. Of course he had never been close enough to a doctor as an adult to be able to find that out. His cholesterol on his exam was well above what was needed for preferred plus rates. In fact it was high enough to bump him two rate classes, but they cut him some slack and only bumped him one class.
He had a similar reaction. Cholesterol is overrated. Insurance companies rip people off. It doesn’t appear he will do the right thing. In this case, just to prove a point, he will go without life insurance.
Men are so stupid, or at least some of them. They will poo pah cholesterol, high blood pressure, weight, family history and I’ve even listened to them try to minimize heart attacks and bypass surgery. And if they can’t get the best rates, they will use that as an excuse not to carry life insurance to protect their family.
Bottom line. It all comes down to responsibility. If you have a wife or children or owe anyone money, your death is going to have a negative impact on someone. Getting real about your health and stepping up to the plate when it comes to life insurance are important steps toward owning that responsibility. Avoiding the whole thing is just stupid and not one ounce better than that.
August 6th, 2009
Guilty as charged. I am one of those recovering saltaholics that grabs the salt shaker and tops off a meal before I’ve even taken a bite to see if it needs it. I love salt and although I am getting better about at least giving something a taste first, the truth is, well, I’m still recovering and fall off the wagon occasionally.
A high salt/low potassium diet is a pretty reliable ticket to the land of high blood pressure, stroke and some types of asthma. A topic of considerable attention lately has been the unbelievable amounts of sodium found in some of the most popular dishes in some of the most popular restaurants most of go to at least occasionally. Sometimes it seems to me that restaurants offerings are kind of self defeating. They make meals taste good by adding large amounts of salt and it often tastes so good that people are driven to eat every last bite, which unchecked leads to obesity.
Now perspective is a good thing. No reason to freak out if there really isn’t a reason, right? They (whoever they are) say that the maximum sodium intake for an adult should be about one teaspoon daily. I am an admitted saltaholic and if I were presented with a salt free day’s worth of meals, I doubt that I would add an entire teaspoon over the course of a day. That’s a lot of salt!
My downfall comes when I eat dinner out at a restaurant that knows two things for sure. 1. We, as a nation, love salt and want it on most everything we eat and 2. The more salt we eat the more beverages we tend to drink. Chili’s restaurants are one of the most consistent abusers of sodium out there. That one teaspoon is roughly equal to 2300 mg. Just a few of Chili’s sodium busting treats are their boneless buffalo chicken salad which sounds healthy but has 4400 mg of sodium, about twice what you should take in on a daily basis. Then there is their Southern Smokehouse Bacon Big Mouth Burger which tops the sodium scale at 4150 mg.
PF Changs has proven to be the king of salt. Their Hot and Sour Soup Bowl tips the scales at an amazing 6878 mg. 3 times the daily recommended maximum in one bowl of soup. I’m wondering if that soup really, really tastes bad and they hope that enough salt will cover it up.
Given the kind of abuse your body goes through at these restaurants, it’s a wonder that life insurance applications don’t ask where and how often you eat meals out. While hypertension and even a stroke can be underwritten at good rates, if a person is hanging out at the who’s who of salty foods, they have to present a higher mortality risk than those who actually monitor their salt intake at almost any level.
Bottom line. Eating right is simply not part of the American way of life and our habit of ignoring how food is prepared, especially the salt and fat that is used, is a recipe for obesity, type 2 diabetes, high blood pressure and stroke. It may be time to ask for sodium confessions before we order a meal.
May 18th, 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
There was a time when I had a whole different view of obesity and gastric bypass. I think the majority of folks still look at the whole thing through somewhat jaded and certainly uneducated eyes.
I will just be right up front and ask to be forgiven for the way I felt about the issue. I truly had no idea back then just how hard it can be to break the cycle of obesity and I truly had no idea just how at risk of premature death someone could be if they were extremely overweight. I just thought of it as a control problem and a gastric bypass as an easy way out.
After years of study I have a much different view of obesity and just how difficult it is to make meaningful changes in your weight and I also had a much greater appreciation for just how much danger a person was in the longer the weight stayed on. The risk of high blood pressure and stroke, diabetes and heart disease are not things that can be taken lightly and certainly aren’t health issues that, if a person has a way of stopping them, should be put off or ignored.
The studied truth is that for those whose health is at risk due to obesity, gastric bypass is starting to not just be seen as measure of last resort, but as a prudent medical decision. Studies have shown that most people being treated for hypertension or type 2 diabetes can be off of medication completely within just a few weeks of having the surgery. In the truest sense the bypass surgery isn’t just a treatment, but a cure.
From a life insurance standpoint, gastric bypass is viewed cautiously until the weight loss has stabilized. This usually takes about a year. It’s during this year that complications can still crop up. Then, most of the companies that are good with obesity issues will want to see a year of stability before they will approve at standard or better rates.
Bottom line. Gastric bypass surgery is not just an obesity easy button. It’s a measured decision that can help save a person’s life.
May 11th, 2009
Sleep apnea is one of those health issues that can elicit anything from a best rate class approval to a decline depending on two things, which company’s underwriter was involved and if you are truly treating the issue seriously.
A layman’s sleep apnea definition might give the wrong impression of why underwriters are concerned. Apnea is actually a period during sleep when a person quits breathing. It is almost always, when they start breathing again, followed by a loud snore or gasping. Sleep apnea is not a mortality issue in the sense that people quit breathing and don’t start again. Think of it as a more severe instance like those when you have been reading or something relaxing and you just haven’t been breathing deeply, and you suddenly have the need for a good deep breath.
So the issue isn’t about whether a person will forget to start breathing or not. Our body takes care of that quite well, albeit a bit loudly. The real issues have to do with the stress put on your body by two things. First, especially in more severe apnea where a person can quit breathing up to 50 times per hour, there is an issue with a lack of oxygen during sleeping hours. The other is that sleep apnea simply disrupts normal sleep patterns and makes for a tired, sleep deprived person the next day.
So the real mortality issues become sleep deprivation and the possibility of a higher rate of accidents, and the oxygen deprivation causing high blood pressure, heart disease and stroke. The other less talked about mortality issue is that your spouse may cause you substantial harm because of your snoring.
So, what do underwriters want to see for optimal results? A good sleep study that defines the problem as mild, moderate or severe. Mild or moderate bring the best results from a rate class standpoint. Probably the biggest issue for an underwriter is what you do about the apnea and how compliant you are with whatever treatment is chosen. If you have a sleep study with a cpap on that shows the cpap reduces your instances of apnea to almost nothing, but you then only use the cpap once in a while, or half the night, compliance is poor and control isn’t good. You aren’t going to win any underwriter points. Surgically corrected obstructive sleep apnea, if success is documented by a study, can put you back into best rate class running barring any other risk factors, such as obesity.
Bottom line. There are real reasons for underwriter caution with sleep apnea, but if you are serious about your approach to treatment there’s no reason you can’t walk away paying very reasonable rates.
May 1st, 2009
Compliance and control! I haven’t beat that drum in a while, but that doesn’t change the fact that those two issues are the major underwriting issues in almost all life insurance applications where health is less than perfect.
I have used that soapbox most often pertaining to diabetes and the fact that without the two C’s, you are not going to like the rates you are approved at (best case) or the fact that you get a decline (worst case). But compliance and control weigh heavily on most health issues from high blood pressure to bipolar disorder.
Compliance could be defined as doing what it takes to stay on top of the health issue. If you have diabetes, for instance, compliance might mean that you check your glucose regularly and that you take your medication exactly as it is prescribed. There is a real tendency for people to get lax with these things and check glucose or take medications when they are having those low glucose kind of feelings. There is also a tendency to be lax about the quarterly followup visits that most doctors want to see. Having full labs done every three months is exactly the way to stay on top of your diabetes and away from all the collateral health issues that could pop up.
So, the same things that are going to positively impact your health are what the underwriters are really looking for. If obesity is an issue, a doctor monitored diet and exercise program. If sleep apnea is an issue, consistent use of a cpap machine. If skin cancer such as basal cell carcinoma is an issue, regular visits to a dermatologist is prudent and reasonable.
Bottom line. Doing the right thing pays dividends. Ignoring them carries a penalty.
April 24th, 2009
It’s just a bad feeling when a life insurance company declines to offer you coverage. They don’t want to accept the mortality risk!! Do they think you’re dying? Is there something your doctor isn’t telling you? Will you ever be able to get life insurance, or are you black balled now?
I can’t tell you how many inquiries come through our website that start, “I’ve been declined by XYZ company due to whatever”. That person’s thinking is that they may never be able to get life insurance for their family’s protection. My thinking is that this is a good place to start! We know who declined the person and we know why so the mission is pretty simple. We need to find a company that doesn’t share the same underwriting philosophy, or figure out if the case was just presented poorly and needs a more complete presentation to put an underwriter at ease.
Supposedly there are about 2000 companies that write life insurance. For many it is just a product they have because they wouldn’t want to miss any chance to make money from you. You certainly don’t think life insurance when you hear State Farm, Farmers or Farm Bureau, but they are licensed to sell life insurance. The only problem is they really don’t care if they do and for that reason their underwriting is definitely anti-approval unless you’re in perfect health and even then their prices stink.
That thought aside, for a minute let’s just assume there was a way to apply with all of the companies at once, all 2000. If you had well controlled high blood pressure you might be approved by
most of the companies, but once you got past the top 100 you would find the rates rather unattractive. If you had a history of asthma I suspect you might be declined by 25% of those companies and the rates after the top 50 would be rather painful to look at.
If you had well controlled type 2 diabetes with no other risk factors I suspect you might get 50-100 approvals and the 10 best rates would be the only rates that didn’t grab your gag reflex and get it going. If you had a history of a low stage and grade prostate cancer you might get 20 approvals and 2 or 3 of those might have a price worth considering. If you have very well controlled bipolar disorder
you might get 5-10 approvals and 2 of those might be workable.
All companies have drawn a line in the sand on just about every health issue you can imagine. That is the bad news. The good news is that for almost any health issue you can imagine there are companies, albeit only a few in some cases, that understand it and as long as treatment is successful, are willing to accept it as a risk.
So why do I consider a decline as a good starting point? Consider the numbers I just presented and consider the odds that your decline came from the wrong company. Declines very often have almost nothing to do with you and almost everything to do with a particular company’s underwriting philosophy.
Bottom line. The chances of turning a decline into an approval are actually very good if you have a knowledgeable independent agent working on your behalf. Don’t take no for an answer.
March 30th, 2009
I knew a guy who made cabinets for a living. He bid jobs through local contractors and directly to homeowners and I could never figure out how he arrived at the prices he presented. There didn’t seem to be a lot of equity between one quote and the next.
Now I know there are differences in materials and I suppose mileage to and from the job site might play into it, but well, it just didn’t add up, so I asked. He explained to me that the calculation was very simple. He could figure the materials right down to the nearest dollar with very little waste. He then added that figure to how much he felt he needed to live on during the period that it would take him to complete the job. If the job was calculated when he had a vacation coming up it tended to be higher than at other times. Very scientific!
Not sure what made me think about that. In life insurance the cost of the job is determined by the health of the applicant and a mortality table, a table that gives the average life expectancy of a person at any given age. Of course in the final price are things like reserve requirements, factors for whether it is paid annually or monthly and, who knows, maybe how much the president of the company feels he will need from each policy sold to live through the next month.
The health of the applicant is a big swing factor since obviously there are those health issues that have an impact on mortality. While we all know people who have lived to better than average mortality experiences while smoking, statistics would show that life expectancy for smokers is shorter than non smokers.
By manipulating the different factors such as family history, driving and drinking habits and whether you have or are treated for high blood pressure, you can see for instance how a 35 year old male who smokes, drinks more than 3 drinks once a week, has 3 or more traffic violations in the past 3 years, has a family history of heart disease and is treated for hypertension, has a life expectancy of 62.3 years.
Compare that with a 35 year old male non smoker, who doesn’t drink and drives very prudently, has a good family history and no problems with blood pressure with a life expectancy of 79.5 years. Even if all of the other factors are in his favor, just smoking reduces mortality by 7 years.
And that is just the surface of a very complex practice known as underwriting. When you consider that obesity is the leading risk factor for diabetes which is a leading risk factor for heart disease, and that each of those health issues has possible collateral health issues, well, sometimes I find it amazing that we can get good, affordable rates for someone who is overweight.
Bottom line. When you apply for life insurance the underwriter has to go figure. While they use mortality tables, they also follow guidelines that have a lot to do with company philosophy. Unless you are perfectly healthy and don’t have any risk factors, the underwriter will have to mix it all together and determine what part of the risk pool you should be paying for.
March 23rd, 2009
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