Posts filed under 'liver functions'
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
Not too long ago I discussed life insurance exam labs results. I mentioned that the tests were not always tests that would lead to a diagnosis of a specific problem, but were tests that often exposed the tip of the iceberg, where a more serious problem might lie hidden beneath.
One such case would be with the liver function test call a GGT, Gamma Glutamyl Transferase. This isn’t a test that you would normally find on your annual exam with your doctor. The truth is that doctors don’t run it and don’t see the value in it. They say it is too “nonspecific” to be of value.
The GGT simply put, measures irritation of the liver. Irritation of the liver can be caused by over the counter medication such as Ibuprofen. Elevation can be caused by drinking and of course, the irritation can potentially be just the beginning stages of something more serious such as cancer.
One of the most common culprits for an elevated GGT is heavy drinking. Not so heavy that extensive liver damage has been caused, but heavy enough that your liver is pretty irritated……at you. For this reason, when there is an elevated GGT on an insurance exam, there is a standing order to run a back up test called a CDT, Carbohydrate Deficient Transferrin. The CDT is known in the industry as an alcohol marker, a very reliable test for detecting heavy drinking. For those with a more clinical or inquisitive mind, here is an article that discusses liver functions and alcohol abuse in more detail.
Life insurance underwriters don’t mince words when it comes to a positive CDT. A positive CDT means that you are knocking back 4-5 drinks or more per day on an ongoing basis. It wasn’t caused by that party over the weekend. Binge drinking won’t cause a positive CDT. So the word from the underwriter that won’t be minced, or misunderstood, will be decline.
There was a company in the not too distant past that felt so strongly about the GGT being alcohol related, that if you had a DUI or alcohol treatment anywhere in your past, even 30 years in your past, even if your CDT was negative, and your GGT was elevated, it was an automatic decline.
Bottom line. Alcohol abuse has been shown in so many ways to have a negative impact on mortality, that life insurance companies simply don’t want to have anything to do with it if they can detect it up front.
September 22nd, 2007
A question that comes up quite often when we discuss the examination part of a life insurance application is, just what is they are looking for? They are going to take blood and urine specimens so they must be on the hunt for something! I think the best way to answer that question is to say that they are really looking for the tip of the iceberg.
Occasionally something big shows up on an insurance exam, something that the client had no idea about. Occasionally lives are saved because people who never really got physicals got an insurance exam that tipped them off to a dangerous situation.
For example, a client had an hbA1c of 11.5 on his labs. He had no idea that he had diabetes and with that lab result, he wasn’t just borderline, he was dangerously diabetic. He went straight to the doctor and 9 months later he had his diabetes well controlled and was able to get a good price on life insurance.
It is fairly common for a person to find out their PSA is elevated for the first time on an insurance exam. Many clients who would not have otherwise seen a doctor, took those results to the doctor and found out they had prostate cancer. Many of those have come back post treatment to get affordable life insurance.
Recently a person who had been treated for prostate cancer applied for insurance and on his exam he had a slightly elevated PSA. Since his treatment was a radical prostatectomy, there should never be a detectable PSA again. He has since found out that the treatment wasn’t successful and his cancer was starting to come back.
Many clients find out that they have elevated cholesterol for the first time on their insurance exam. Another common occurrence is the discovery of elevated liver functions.
The tip of the iceberg for most. A problem discovered early enough that people were able to take corrective action and in many cases, save their lives. So, back to the question about what they test for. I have attached a set of labs from an insurance exam.
labs.pdf
Most of what you see is the normal stuff. In addition to what your doctor might run in a general physical, insurance companies also test for HIV, nicotine and drugs.
Bottom line. Insurance underwriters are looking for the obvious full blown health problems, but mostly what they find is the first clue that a problem might be brewing.
August 31st, 2007
I can hear mom now. Eat it! It’s good for you! Well, back when I was growing up and my mom got broccoli and spinach out of a can, it not only tasted bad, I doubt seriously if it was really good for me. Now, fresh broccoli presents a whole other side of the story, and posssibly a way to lower your life insurance rates if you end up with prostate cancer.
I know some of you reading this are wondering how I am going to pull that whole mess together into important information. The truth is that eating broccoli won’t prevent you from getting prostate cancer. But, Paul Harvey isn’t the only one with “the rest of the story.”
But remember how underwriting works with prostate cancer? The lower the stage and grade, the sooner you can get life insurance at affordable rates. Very often, given a low stage and grade, better than standard rates can be found within six months after treatment, as long as the treatment accomplished did what it was supposed to do.
So the link is broccoli and a low stage and grade. Martha Edwards on thecancerblog.com referenced a study that stated “while regularly eating fruits and vegetables didn’t necessarily reduce one’s risk of prostate cancer, eating lots of leafy greens–particularly broccoli–was associated with a reduced risk of aggressive prostate cancer.”
Bingo! Get rid of aggressive and you’re in the hunt for good life insurance rates. I’ve heard that there is a study that shows that most males will have prostate cancer before they die. I haven’t seen the study and if anyone has, I would love to hear from them. The premise is that while most men will have it, most of them will die from something else and never know it. Maybe those that never know they have it are broccoli eaters. Maybe we should all be broccoli eaters.
Bottom line. Prostate cancer is not going away. We should do all we can to negate it’s impact on our lives.
August 9th, 2007
One of the most important factors in life insurance underwriting of significant health issues such as diabetes or heart disease is a person’s willingness to do what it takes to manage the health problem. If a person is compliant with their medical advice and keeps all the risk factors controlled, mortality experience improves and better life insurance rates follow.
Roche Diagnostics did a study recently that showed that 80% of adults say they would step up to the plate and do what it took to self manage a chronic illness. That would be great if it matched reality. In an article in Medical News Today , statistics show that those who actually do have chronic illness don’t do as well as others think they might at self management.
I don’t offer this to put any shame on those who are suffering from challenging health issues. I think the truth is that, like a lot of things in life, we tend to believe we can handle something we’ve never really experienced. We tend to think of these challenges in the context of making it through a day in someone else’s shoes. We don’t fully grasp that we might have to put those same shoes on every day for the rest of our lives.
Bottom line. Managing a chronic illness is hard work. If it’s not managed it will likely shorten your life expectancy. People who step up to that plate everyday have my respect and my prayers.
August 3rd, 2007
Hep C is the most common chronic blood borne infection in the United States. The insidious nature of the disease is such that often people will not experience symptoms for years, even decades, after they are infected. Life insurance underwriting for Hep C is a careful process and is really broken down into two parts.
The first part is the obvious. You have the disease and it was treated. What medical problems did the disease cause while you had it and what is the current status of the disease and it’s main target, the liver. Current status can be summed up with lab tests that show liver functions and the viral load. To determine potential problems that a person may have incurred from the disease it is very common for a liver ultrasound or biopsy to also be done to see what damage the liver has incurred.
The other underwriting factor is the impact of the treatment . The most common treatment today is interferon. While it is successful in reversing about 50% of Hep C cases, it’s side effects are not light weight. Along with things you might expect like fatigue, interferon can cause flu like symptoms, loss of appetite and in some case large fluctuations in blood sugars which can lead to diabetes.
From an underwriter’s point of view, better than standard rates can be given if liver functions are within the normal range and you have a negative viral load. There also should be a liver biopsy that shows little or no permanent damage to the liver. The concern is that in prolonged untreated cases, cirrhosis can be an issue.
Once the issue of the liver is hurdled, any residual effects from the treatment have to be considered. Generally there will be a waiting period after the completion of interferon treatment before a good offer can be made. The waiting period will vary depending on the level of the disease upon diagnosis, the agressiveness of the treatment and how well your body handled the treatment.
The waiting period can be from 1 to 10 years depending on all the variables before the best possible rates can be approved. That doesn’t mean insurance can’t be obtained, but it may cost more for an interim period.
Bottom line. Know all the test results before contacting an independent agent. Actual copies of the lab and pathology reports are helpful. If, given your situation, you don’t qualify for the best possible rates right now, put what you can in force and work with your agent each year to review and try to improve on the rates until you get what you need locked in.
July 26th, 2007
You know the rates I’m talking about. You see them on TV, in magazines and on the internet. Rates so low that they make even the most seasoned, die hard, disliker of life insurance consider running right out and getting some. They’ve been called Superman rates. Life insurance agents who don’t sell for those companies claim that those rates are the bait in bait and switch.
The actual rate class, depending on the company, might be called preferred plus, preferred best, select preferred, or my favorite………….SUPER PREFERRED!!!!! Whatever they call it, needless to say, you have to be healthy to be approved at that rate. And that doesn’t necessarily mean healthy in your way of defining healthy, but rather healthy as defined by the company’s underwriting guidelines.
I’ll get into some of those guidelines in a minute, but I want to dispell with one of the myths about the best rates available. A rumor, started no doubt by someone who didn’t qualify for the best rates (I used to, but don’t anymore), is that companies will look for some way to keep you out of that rate class. They might even make something up just to disqualify you and make you pay more. Nothing could be further from the truth. Hundreds of my clients, the oldest being 81, were approved at the best rates available. None of them admitted to being Superman (or woman), but they did all have one thing in common. Every part of their exam, from their height and weight, their blood pressure, their cholesterol, blood sugar, liver functions, protein levels, family history, and on and on, were all within the guidelines.
Companies set these guidelines based to the best of their ability based on the study of the mortality experience for people who are and aren’t within the guidelines. The further out of the guidelines you are, the higher the rate you will pay. Is it fair? I think it is although I have certainly questioned my fair share of underwriting decisions. But, the line has to be drawn somewhere and if the underwriting criteria and associated rates are going to have any integrity, they have to be followed somewhat diligently.
I’ll just touch on a few real life guidelines and a few cases where people were so close they could see super preferred, but they didn’t get it. Many of you who have life insurance policies more than two years old might say that the companies aren’t this fussy. They weren’t two years ago. They are now. I will explain why that happened in a future post.
Now keep in mind that there is generally about 20%-30% difference between the best rates and the second best rates a company offers. So, when you don’t qualify with Superman, it hurts a bit.
One company guideline allows a total cholesterol of 220 and a cholesterol ratio (total cholesterol/hdl) of 5.0. I have had clients not allowed the best rate with a total cholesterol of 222 and another with a cholesterol ratio of 5.1. The beauty of working with an independent agent is that they can, if the company digs in their heels about those kind of results, move the business to a more flexible company or one with guidelines that fit the situation.
Bottom line. The rates are available. Working with an independent agent will give you the best possible chance of acquiring those rates. If you don’t get the best rates, like me, don’t let your ego get in the way of doing the right thing and buying life insurance.
July 25th, 2007
No there’s a couple of items there that are taken very seriously by life insurance underwriters. During an initial interview with a good independent agent they are going to ask about any history of alcohol abuse, treatment for alcohol or drug abuse and any dui’s you may have had. May seem a bit invasive for your first chat with that person, but let’s be honest, these issues, depending on when they happened and how severe the problem was or is, can have a definite effect on mortality.
Several underwriting issues come into play when alcohol is abused. Very often, for those who don’t fess up to being heavy drinkers, the underwriter gets the first hint from elevated liver functions. Liver is working overtime for some reason and one of the most common is the attempt to metabolize alcohol. Very often when elevated liver functions are found the company will run an alcohol marker test which will indicate if a person has driven their liver to distraction with alcohol or if there is some other reason for the elevation.
So, one of the first issues is that of health. If you are doing damage to your liver, then chances are you are putting yourself at risk for other health issues.
Next, and by no means second to the health issues, is the issue of lifestyle and alcohol abuse. Alcohol and drug abuse can both lead to some very poor lifestyle choices that can impact mortality.
And of course DUI speaks for itself. There is the very real potential to kill yourself or someone else if you are drinking and driving. Killing yourself is an obvious mortality issue and ending up in jail for vehicular homicide presents a second issue an underwriter needs to consider. Life insurance companies aren’t real keen on insuring people who may kill themselves or end up in jail. They take special exception to a person with a recent dui that is also a private pilot.
Now the good news. Time does heal. Kind of like traffic violations and your car insurance, the further you are from the last incident, the better the chances of getting good rates. So, given time most companies will allow that DUI to melt away. Do it more than once and it won’t melt near as fast though.
Alcohol and drug abuse and the ensuing treatment also can be insured after some time. Companies do like to see that you have sought professional help and they also like to see preventive measures such as being a member of AA or NA.
Given enough time, any of these issues can get all the way back to best rates. Check with a good independent agent if any of these issues are in your past.
April 11th, 2007
A person’s build, their height and weight and how that is distributed, is probably the biggest bone of contention in life insurance underwriting. Unlike lab results like cholesterol or liver functions, people can try to chase the weight rabbit a few different directions before they have to deal with reality.
The most common argument thrown about to justify weight is that “I’m a large boned person”. To kind of put this in context let’s draw a couple of pictures of life insurance seekers. One is 5′10″, 185#’s. The other is 5′10″, 240#.
Now I’m a big believer in large boned people. I don’t think they’re lying abut that. While I couldn’t find any reliable articles that actually substantiated the situation, I did some figuring on my own. The following is the big boned facts according to Ed. I’m 5′10″, 175#. Not skinny and not fat. I’m pretty sure I’m not big boned either. I’m thinking “big bones” may add 10% to a person’s body mass. That means that a big boned Me would weigh 192.5#.
On average the people that use the big boned argument are jousting around about 25% above the high average weight for their height. In other words, what life insurance underwriters hear a lot of, is someone 5′10″ and 230#’s saying they are large boned. I guess the bottom line from my unscientific best guesses is that they may very well be large boned, but they have also padded their large bones substantially. Wouldn’t want to break a large bone after all. Healing time is probably much longer than a normal bone.
The other argument thrown out there for larger than average builds is that the person is a weight lifter, a body builder. Now this is a tough argument. There isn’t any doubt that a true body builder has substantially extra muscle mass and weight. 5′10″ and 230#’s might very well be the optimal weight for the true body builder. That’s just a guess, so if you are a body builder and that is really fat or skinny, I didn’t mean to offend you.
Back to my two examples. At 5′10, 185#’s a person, absent any health issues, should qualify for the best rates with most insurance companies. At 240#’s a person would qualify for a standard rate at best. The difference for a 45 year old buying $500,000 of 20 year term insurance is $340 a year if you’re the small guy and $630 a year if you’re the large guy.
I have seen a few underwriters allow some slack for the weight lifters, provided they supply body measurements from their doctor and a photo to go with it. They still won’t make it to the best rate with any company, but they will likely fare better than their big boned counterpart. An independent life insurance agent can help you track down the companies that might have a little wiggle room.
As for the big boned person. Well, a build chart is a build chart and every life insurance company has one. They have to draw the line somewhere and absent a disection to prove the big boned theory…….honestly even with the disection, the underwriter will stick to the build chart.
Now take heart. Not all companies use the same chart and an independent agent can often find you a better rate class than you might otherwise be stuck with. While there is very little wiggle room on a company’s best rate class, they will occasionally bend a bit on other rate classes as long as all other risk factors are in your favor.
April 10th, 2007
I don’t think I would be overstating the subject at all if I said that at least once a week I have a client who, for the first time, discovers they have a health issue because the life insurance exam lab results bring it to light. Some of the most frequent revelations that come from those lab results are high cholesterol often coupled with low HDL (good cholesterol), elevated liver functions, elevated PSA (prostate specific antigen) and very often elevated glucose accompanied by an elevated A1C, a measure of long term glucose averages.
While life insurance agents shouldn’t practice medicine, the next step should be to encourage their clients to see a doctor and get a professional opinion. After they’ve done that, a good independent agent can give them guidance as to the steps that are necessary to get them back on the path toward competitive life insurance quotes.
There is especially good news for a person whose labs indicate undiagnosed borderline diabetes. That is to say that they have an A1C of 6.5 or less. If all other risk factors are favorable, an independent agent has access to rates for that person that are as good as Superman can get, provided Superman’s labs are normal also.
For those that have already been diagnosed with diabetes, there is more good news. Provided they have good control, an A1C of 7.0 or less with all other risk factors being favorable, better than standard rates are very attainable. It is not unrealistic for a type 1 diabetic that does all the right things and whose labs show well controlled glucose levels, and no collateral health issues, to be able to get preferred rates. It is completely reasonable to expect a type 2 diabetic who is prudently taking care of their overall health to get preferred or standard plus rates. These are good rates folks. There are plenty of us who are happy to get those rates without the challenge of diabetes.
In summary, the way to life insurance rates for either a type 1 or type 2 diabetic is control. An A1C (and please, if you don’t know yours, call your doctor) of 7.0 or less is good, 6.5 or less is great. Between 7 and 8 is still in the running for good rates as long as the other risk factors are in control. I’ve mentioned the other risk factors a few times. What underwriters want to see is, if there is hypertension (high blood pressure) that it is well controlled. If you are overweight and your medical records show that you are doing something about it, that is a real plus. They want to see compliance with your physician. Stated another way, do everything and exactly what the doctor says religiously. They want to see people who are consistent about self monitoring and about doctor followups.
Checking your glucose occasionally and going to the doctor once a year is not the way to good health or good life insurance rates.
February 21st, 2007
