Posts filed under 'liver functions'
An extremely common cause for the derailment of a life insurance application is an elevated liver function test (LFT) on the life insurance labs. This can result in an unexpected (and unwanted) butt kicking when you had no idea that there was anything going on.
To make matters worse, that butt kicking may not have any medical science or mortality studies to back it up. It is just the way it’s been done forever. 10 years ago I sold a lot of insurance for a company called Federal Kemper (you old folks might remember the commercial with the Kemper Calvary!!??) Well, Kemper had an opinion about one of the LFT’s. If you had a DUI ever in your life and your GGTP was elevated at all, say 66 (0-65 being normal), you were automatically declined. I had a case where the DUI offense was 30 years prior. Still an auto decline.
GGTP is a liver function test that is not commonly used by physicians but is almost always used by insurance companies. Most underwriters say they like to GGTP because it is a non specific test, showing positive when there is any kind of irritation of the liver. Other underwriters like those at Kemper didn’t make any apologies for the fact that they thought anyone with an elevated GGTP was a lush. To them, the only reason for the elevation was alcohol abuse.
The other two LFT’s used commonly by doctors and insurance companies alike are the AST and ALT. By far the majority of companies out there will postpone, if not decline, an application in the presence of elevated liver functions. A postpone would be to give you time to get a complete workup to determine why the liver function was elevated. A decline would be, well, to get rid of you.
The problem with this blanket rush to judgment or even overt concern in the face of elevated liver functions from an underwriting standpoint is that while an underwriter can certainly look at the result and say that something may be abnormal, they have no idea what, to what extent, or even if the results are accurate. They most certainly can’t pin any kind of an accurate mortality risk to the results. Liver functions change rapidly and can be very different two weeks from now than they are today in the absence of something like a disease that is consistently and constantly stressing the liver.
The good news is a leading company that has written guidelines that allow clients to get past the initial knee jerk decline. Just an idea how far this company has separated itself is the fact that they won’t even rate a client with a single LFT elevation within certain limits. In other words, if just one of the three LFT’s is elevated you could still get preferred plus rates. Their guidelines would allow no rating if the GGTP is 4 times normal or lower, the ALT is 4 times normal or lower or the AST is 5 times normal or lower.
Their guidelines also allow best rates if two or more liver functions are elevated but not more than 2 times normal. For the millions each year that are declined, postponed or highly rated for these same kinds of results, this is great news.
Bottom line. You can say it a million times but sometimes it just keeps begging constant repeating. Not all companies treat all underwriting the same. What you car insurance company offers on life insurance has no bearing on what you can find through a knowledgeable independent agent.
September 22nd, 2009
“Life insurance companies are just trying to figure out a way to raise my rates. My doctor says there’s nothing wrong with my …….”.
It’s a real dilemma. Who do you trust? The doctor that’s known you for years and you pay the big bucks to on an ongoing basis to monitor your health, or the life insurance underwriter who gives you a free second opinion with a twist, a picture of your potential mortality experience.
Although it happens, the ball almost always comes to rest in your doctor’s end of the court. There is that relationship after all, and how could an underwriter who’s never even met you know more than your old friend, the family doc? Buried in this conflict is the rub. Somehow for the person applying for life insurance they see doctors and life insurance underwriters having the same job, sort of. They both know about medicine, illness and health, right?
The reason this gets messed up is that your doctor is there to make sure you feel good, take care of illness and do their best to help you live a long, healthy life. But you will ever hear a doctor say that “you’re doing just great and unless something else pops up, you can expect to live another 23.2 years”. They stop at the doing just great part and tell you when they would like to see you again.
A life insurance underwriter really doesn’t care how you feel. They simply use the law of large numbers to estimate your potential impact on a pooled risk of life insurance owners and assign a rate or decline you accordingly.
I had a client today who had been rated up by a company due to a liver function test called a GGTP. Insurance companies all use this test and I doubt if you can find any doctors that use it. When the client told his doctor that he had to pay a higher rate due to his elevated GGT, the doctor dismissed as insurance company nonsense. He told the client that it was an irrelevant test.
And it may be to the doctor. Doctors usually depend on the other liver function tests, the AST and ALT and because the GGT is a non specific test, they don’t use it. While there are a lot of things that can cause an elevated GGT, what it does show without any doubt is that the liver is under some source of irritation. While there are plenty of things that can elevate the GGT without affecting the other liver functions, one of the most common is over indulgence in alcohol.
Your doctor isn’t going to test for something like that. He’ll ask you about your drinking habits and leave it at that. A life insurance underwriter will see a significantly elevated GGT and order an alcohol marker called a CDT. A positive CDT is an automatic decline with every company I know of because it means you drink a bunch of alcohol. The likelihood that you are going to tell your doctor that you are a lush is pretty slim, about as slim as you telling a life insurance agent. But, that’s important information for life insurance underwriting. Drunks simply don’t have the same mortality experience as sober people in general so they shouldn’t get the same underwriting consideration and result.
Having been the person caught in the middle on a large number of occasions, I can tell you that there is no easy answer. I think it is important not to dismiss as irrelevant the information that comes from life insurance underwriting. Even when it goes against what your doctor says, it is worthy of some personal education and study.
Bottom line. Are life insurance companies out to find ways to raise your rates? The answer really is no. Are they out to make sure they aren’t tipping the balance of the risk pool by ignoring information? The answer is absolutely yes.
January 19th, 2009
With very few exceptions life insurance applications are accompanied by a physical exam and blood and urine tests. Occasionally the issue of a blood draw can complicate things with people whose veins are hard to find or those that are just plain freaked out by needles.
The two options that are available for someone who simply refuses to have blood drawn would be simplified issue life insurance (no exam), or in lieu of a blood draw which generates a couple of vials of blood to be tested, a few companies will allow a “finger stick” which generates far less blood and narrows what the company can test for simply due to volume.
First let’s put this in perspective by using a sample client. A man in his early 50’s. Trying to quit but still actively smoking. Good health and family history. He just had a horrible experience with a blood draw when he had shoulder surgery a few years back. If we did a full exam and blood draw his price for $250,000 of 15 year term insurance would be about $1500 annually.
To go with simplified issue insurance where there is no exam and no blood or urine specimens, the best price on the same amount and term length would be $3892 annually. Taking this course of action to avoid giving blood would cost about $2400 more per year for 15 years. I don’t know, but I’m thinking I could figure out some way to give blood to save $36,000 over the life of the policy.
The other option, the finger stick, will generally not be allowed for preferred rates, so in this case the person would be looking at standard smoker rates and the best of those with a company that will accept a finger stick would run $2600 annually, an additional $16,500 over the life of the policy.
So, what does a company lose by not doing a finger stick versus a full blood draw? One of the losses is a lipid panel, cholesterol, triglycerides, hdl, ldl, etc. They are also lacking the blood it takes to run liver and kidney function tests. No PSA test. That is a lot of health information that the insurance company is going to forgo a glance at, and the less information they have to help determine potential mortality, the higher the price. Obviously with a simplified issue policy there are no tests and not even an examiner who gets to look you over, so the company is assuming risk without full information (remember Reagan, “trust, but verify”), so again an even higher price.
One option that can occasionally save the day is that those who are hard blood draws and are scared to just let any old nurse working for an exam company do it, may have a favorite nurse at their doctor’s office who can get the blood on behalf of the exam company. There are some guidelines that have to be followed, but sometimes it works.
Bottom line. The best rates for life insurance come with the best, and most, possible information for the insurance company to scrutinize. A few tips for those that have a hard time giving blood. Drink more water than usual in the 12 hours leading up to the exam and, if you’re up for it, do some push ups right before the blood draw.
November 25th, 2008
Well, no…..or maybe yes……it all really depends. I hope this information has been helpful.
Seriously though, underwriting of Hepatitis C really comes down to a few key factors. First, is the disease in remission and second, how much damage has the liver sustained? Remission, if achieved, usually comes after treatment with interferon.
The goal, the measure of remission, is whether liver functions are normal and a negative viral load has been achieved. While it varies depending on the progression of the hepatitis, generally the treatment and return to normal labs will take two to five years. Once those benchmarks have been achieved it is possible to get standard rates from some companies. Prior to those benchmarks being achieved companies vary between highly rated policies or a decline.
The other factor looked at is the results of liver biopsies. Obviously any serious liver impairment has long term health consequences and each case would have to be reviewed by a medical director to determine the extent of the risk. Again, like the previous variables, if liver damage is relatively minor or non existent, standard rates should be attainable through several companies.
Bottom line. Hep C is not the end of the world for reasonable life insurance rates and the rumor going around that once you have Hep C you are uninsurable is simply unfounded. Seek out an independent agent and have them shop it for you.
October 29th, 2008
Remember the good old days when livers were done in by drinking too much? Cirrhosis of the liver can eventually lead to liver failure or liver cancer, kind of a no win situation unless you have a spare hidden in the closet.
Now studies show that obesity can lead to a situation called non alcoholic fatty liver disease, which left unchecked (you don’t lose weight), can lead to cirrhosis, failure and cancer and eventually to that hunt for a spare liver. This is becoming alarmingly frequent in young people who, unfortunately, are rarely tested for liver functions.
I will continue to beat this obesity issue to death just on the off chance that someone, even if they aren’t in the market for life insurance, will read and learn that the number of ways that those extra pounds can kill you is simply staggering. Diabetes, high blood pressure, heart disease, stroke, several kinds of cancer and yes, liver disease.
Just a few plugs for common sense. If you are obese and don’t have any of these things going on yet, buy life insurance now. If you are obese and can’t lose weight through traditional methods, seriously consider gastric bypass. Forget those people who say that’s just taking the easy way out of your problem. This is about your life and saving it. Just consider it. Talk to your doctor.
Bottom line. The weight of obesity is crushing our nation and especially the young people. Overweight teens have no concept of the problems they will be facing in their 30’s and 40’s if they don’t do something now.
September 9th, 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
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
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