Posts filed under 'melanoma'
The most common type of cancer among men and women is skin cancer. By far the majority of those cases are rarely life threatening types like basal cell carcinoma or squamous cell carcinoma.
The least common of the three is the most feared and has one of the highest mortality rates of any kind of cancer, melanoma. While history of the first two types is pretty easy to get good life insurance rates on, when melanoma jumps into the picture, well, the picture changes.
Like all cancer the underwriting gets tougher as the stage and grade of the cancer get higher. The best possible situation whether it is melanoma or breast cancer is a stage 0 insitu where the cancer is fully encapsulated. I recently shopped a stage 0 melanoma and got two offers better than standard on a cancer diagnosed less than a year prior.
Generally with anything higher than a stage 0 there would be a minimum one year post treatment before any offer was made and depending on the stage and grade, it could easily be a highly rated policy for several years after that. That highly rated period depends on the type of cancer as well as the stage and grade.
Bottom line. With this case we are headed for final underwriting and it appears our trial offer will be met and a standard plus rate offered. If you have a history of melanoma and want to see what kind of rates are available, make sure you have the stage and grade memorized and even better, a copy of the pathology report for your agent to work with. You may be pleasantly surprised.
November 12th, 2009
There is skin cancer, the most common cancer in the United States with over one million cases annually. Not to trivialize, but most of those cases are basal cell or squamous cell carcinoma and are generally easily and successfully treated.
It is the third in the trio of skin cancers that can and often does change and end lives, Melanoma. Melanoma, while a skin cancer, is extremely aggressive and invasive.
As with most kinds of cancer, early detection and treatment is the key to winning the battle. Self magazine recently ran an article on the ABC’s of Skin Cancer and gave a 5 step list for self examination and identifying problems while still in the early stages. The real message from this timely article was not to get caught sitting and watching a mole change or grow.
From a life insurance standpoint Melanoma is a tough challenge. The real issue is stage and grade, how advanced is it and how deep is it. A melanoma in situ is the best case scenario. Fully encapsulated with very shallow margins, a melanoma in situ can be removed surgically without concern of spread. Generally shortly after successful treatment standard or better rates are available. The deeper the Clark’s level of the melanoma the tougher the underwriting. With higher grade cancers it can be as long as 10 or more years before you can get back to standard rates and it is not unusual, just because of the tenacious, aggressive nature of melanoma, that once you have had it, you might never do better than standard rates.
Bottom line. Vigilance is the key. Don’t poopah that mole. Get it checked out by a dermatologist and if it starts changing at all, run, don’t walk back.
June 23rd, 2009
Continuing on with a series of posts I started last week on life insurance applications I would like to discuss the necessary (by law) and often misunderstood Authorization to Obtain Information or HIPAA authorization.
HIPAA, the Health Insurance Portability and Accountability Act, is the program that protects sensitive personal information from being used for other than the intended purpose. Even though its’ intent is to protect consumers, on occasion consumers take exception to the language in the authorization. I have even had potential clients, assuming that I am the only agent out there that requires the form, decide not to apply through me and go elsewhere in search of an agent who won’t be so potentially invasive. It’s rare, but when someone digs in their heels on the issue, they don’t buy my assertion that the same language is part of all life insurance applications through all companies and all agents.
So, what is this document? Why do people take exception to it in some cases? I have extracted a fairly common hipaa-authorization from a Banner Life term insurance application. While the documents differ some from company to company, they all have to meet the same legal requirements for language and content.
For those that do take exception to the authorization, and honestly they are few and far between, the first thing they take exception to is the expansiveness of the authorization. It allows the company to obtain full medical records, even from mental health facilities, and any other protected health information (protected under HIPAA) occurring during the last 10 years to the company’s agents, employees, vendors or representatives.
First let me be clear that full medical records and other health information are separate. Some try to interpret that in their favor as the company only being interested in medical records for the last 10 years and therefore only being interested in your medical history for the last 10 years. This would be a stroke of luck if you happen to have had a melanoma or a heart attack prior to 10 years ago, but that’s not the case. The company wants to know all of your medical history and the authorization allows them to obtain all of your medical records.
Another question that occasionally pops up is why the authorization is valid for two years. You may remember from previous posts that life insurance policies have a two year incontestability period. Should you die during that period the authorization can be used to obtain medical records needed to ensure that the claim is valid.
This authorization also rescinds, for the purpose of this application, any private agreements you might have to restrict access to all of part of your medical records. Simply put, if you want to apply you forfeit the right to pick and choose what the insurance company can see. And finally the release is very straight forward. If you refuse to sign the authorization the company doesn’t have to process your application.
Bottom line. While the document might seem one way, it really accomplishes something for both you and the company. It allows them to get all of the information needed to fully underwrite the policy and it lays down clear limits on who can see the information and how it can be used.
May 4th, 2009
Considering the turmoil of the economic meltdown that was 2008, it’s always good to find and hold onto bright spots. Here is just a quick review of a few of those bright spots coming from a most unlikely source, life insurance underwriters.
For years there has only been one company that would allow their best rate class for well controlled, treated high blood pressure. For those of us who deal with this issue and watch companies inflict a 30 percent hit on those who are often treating borderline blood pressure issues, to now have two companies that will allow treatment coupled with good control is a home run.
Another health concern that took a turn back toward sanity this year was the issue of basal cell carcinoma and specifically the underwriting treatment of someone who has had multiple cases. A few years back there was a study that showed there might be a link between those with multiple basal cell cases and the potential for melanoma, the deadly skin cancer cousin. At the time most companies changed their underwriting of multiple basal cell cases to best case standard rates, about 100% higher than their former stance that basal cell was not a rateable issue. This year many companies reversed course on that decision and have once again decided that basal cell, whether a single incidence or multiple, shouldn’t impact a person’s rate.
Diabetes made some headway this year. Without going into all the detail it needs, suffice it to say that there has been some loosening of the standard guidelines for earlier onset type 2 diabetes and some significant changes to the guidelines for type 1 diabetes. All of these changes have one thing in common and that is the assumption of good control.
Anyone who has followed my rantings about life insurance know that this has been a year of significant gains in underwriting of bipolar disorder. Hinerman Group has successfully placed more cases this year than any previous year and all indications are that the trend will continue. Again, there shouldn’t be any assumption that life insurance is a guaranteed thing with bipolar, but given good compliance, good control, and a level or work and social stability, good rates are achieveable.
Bottom line. The headway made in 2008 is a trend that we expect to see continue. Some of it is attributable to changes in insurance company change in philosophy. Much of it is attributable to the growth and change we’ve achieved on our end. We are doing a better job of understanding what will move an underwriting decision and also in forging new underwriting relationships and solidifying those who we have counted on for years.
December 26th, 2008
Skin cancer is the most common cancer among both men and women in the US. Life insurance underwriters have shown a lot of movement on their underwriting guidelines for skin cancer over the past several years. Unfortunately, until recently, it didn’t seem to be in any clear direction.
Probably the best news has been in the risk evaluation of low stage melanoma. Melanoma is the least common skin cancer but accounts for 75% of skin cancer deaths. But, what we’ve seen recently especially in stage 1 and 2 melanoma , is a tendency to get back to standard rates quicker after surgical removal of the cancer. While higher stages may incur a flat extra for a longer period, lower stages can generally be seen within a year with no recurrence.
The other significant shift in skin cancer underwriting has come in basal cell carcinoma and squamous cell carcinoma. In the past these two generally flew under the underwriting radar because of the relatively low mortality risk. A few years ago a study indicated people with multiple basal cell carcinomas were at increased risk of acquiring melanoma. This led to an underwriting swing away from ignoring basal cell to offering no better than standard for people with multiple instances. This stance has also softened somewhat with further studies showing the connection to be more vague than first thought.
Bottom line. Once again, this is not an area where your car insurance agent is going to shine, and I wouldn’t depend on large internet agencies to really dig in deep and get the job done as it should be. A knowledgeable independent agent should be able to ferret out the best opportunities for low rates with your particular history of skin cancer.
July 29th, 2008
In my experience it is the guys in this world that not the brightest lights on the block when it comes to preventive measures like using sunscreen, wearing hats and not overexposing themselves to the sun. I would put my money on men to be the first sex to be overwhelmed and become extinct due to skin cancer.
Growing up on a golf course or at the lake, I know that sunburns were worn and compared like badges of honor. Losing multiple layers of skin over the course of a summer was a job well done.
Now an alarming study shows that men, for all of their brainless effort for the last 30-40 years, are being left behind when it comes to increases in the number of new melanoma cases. Since 1980 diagnosis rates in younger (15-39 year old) men have remained level while the number of younger women diagnosed has risen 50%. Melanoma is the most dangerous of the three types of skin cancer.
This is especially foreboding since most skin cancer is diagnosed at older ages. There were a couple of factors noted that may have contributed to this disparity in the rise of melanoma cases. First, woman are more likely to wear sunscreen and because of that, may expose themselves to more sun because they feel protected. The other culprit could very well be tanning beds. Not a lot of guys hang out in the UV sandwich looking things.
From a life insurance standpoint melanoma is a serious subject, and for good reason. Unlike its’ less potent cousins basal cell carcinoma and squamous cell carcinoma, melanoma kills. Depending on the stage, grade and depth, it could easily be three to five years after treatment before reasonable rates are available and melanoma is one of those health issues that may very well prevent you from ever getting better than standard rates again.
Bottom line. It remains to be seen what these statistics in “younger women” foretell 20 years down the road. Time to rethink our rethinking of our relationship with the sun.
July 11th, 2008
The word cancer used in reference to anything to do with life insurance usually conjures up visions of declines and huge rates. In that regard skin cancer is something of a different animal.
Skin cancer is the most common cancer in both men and women, mostly thanks to the fact that most of us had no idea that sun could be harmful 30 and 40 years ago as we religiously broiled ourselves at Memorial Day lake parties. There are three types of skin cancer.
Basal cell carcinoma, sometimes called non-melanoma skin cancer is the most common. It is most frequently seen in light complected people. Basal cell has about a 95% cure rate, so it isn’t the most feared cancer by any stretch, but recent surveys have shown that multiple basal cell instances put a person at higher risk of more dangerous skin cancer. This fact has not been lost on life insurance underwriters who, as recent as five years ago, didn’t rate basal cell at all, not even multiple instances. Now, while most companies will let a single instance slide, multiple instances may bump a person to standard rates.
Squamous cell carcinoma is almost identical to basal cell except in one aspect. Basal cell, in the 5% of cases where it becomes a problem, generally goes deeper into the skin and can sometimes reach the bone, but it doesn’t spread to other areas of the body. With squamous cell, the cure rate is essentially the same, about 95%. The issue with the other 5% in this case is that squamous cell can spread to other parts of the body. Underwriting on squamous cell will depend on the stage and grade and if it has spread. If it is a low stage and grade with no spread, often preferred rates can be done if there is a single instance. Multiple instances would be standard rates best case.
Melanoma is the last of the skin cancers and although it represents only a few percent of the total skin cancer occurrences, it is responsible for 75% of the deaths. Underwriting melanoma is a whole different ballgame. With a low stage and grade melanoma, the best case would be a rated policy (higher than standard) when you’ve reached one year post treatment. That is best case. Remember, with cancer it is all about stage and grade. I’ve seen melanoma history get no better than standard 10 or more years after treatment.
Bottom line. Skin cancer is not an issue that you want to tackle without an independent agent. Most life insurance companies will be more cautious than I have described.
May 28th, 2008
Guys! The boogie man isn’t under the bed, but rather right below our belly buttons, just about a finger’s length up our rear ends. I’m talking about the prostate gland and the fact that 1 in 6 men will get prostate cancer in their life time.
Prostate cancer is the second most common cancer right behind the skin cancer trio of basal cell carcinoma, squamous cell carcinoma and melanoma. While a statistically huge number of us will be diagnosed with prostate cancer, the good news is that the survival rate is very good, with only about 1 in 8 who are diagnosed actually dying from the cancer.
It is this survival rate, driven by early detection and effective treatment options, that makes prostate cancer one of the easiest for life insurance underwriting. The earlier the cancer is detected, the lower the stage and grade and the better the treatment results. With more and more men getting regular PSA tests, expect that survival rate to climb in the future. By the way, my most recent health fair results showed my PSA at .9, down from 1.1 two years earlier. Safe for now.
I’ve review a lot of articles about prostate cancer and how to avoid it. This one I read just recently is kind of like just doing what your mother said. Eat your vegetables! Sure can’t hurt and it tastes good too.
Now, back to the subject at hand. As a baseline underwriting view, if your cancer is diagnosed when the PSA is 10 or less and the biopsy shows a stage of T1 or T2 with a Gleason grade of 3+3=6 or better, depending on treatment results you could be back from the brink of uninsurable to close to standard rates in a year. That scenario would be if treatment was a radical prostatectomy and your PSA was at 0 for a year. With other treatment options the time frames can change.
Bottom line. Good news. Ultimately very survivable and very insurable. Talk to an independent life insurance agent about it today. Make sure you have a copy of your biopsy and that you know all of the relevant test results. The more information you can provide, the better the chance of finding good rates.
May 23rd, 2008
If you’ve been around life insurance long enough you begin to see that there are companies whose underwriting guidelines kind of float on the breeze and then there are those who truly do their homework and strive to make reasonable decisions.
I have commented in previous posts about the shift that happened a few years ago with a lot of the “float on the breeze” companies. A study came out that indicated that people who had multiple incidents (more than one) of basal cell carcinoma, the most innocuous of skin cancers, had a higher risk of having melanoma, the deadliest of skin cancers. At least this study was cited to me by underwriters. The nearest article I could find that leaned in that direction merely indicated that if you’ve had basal cell once, there’s a 30% chance you will have skin cancer again within 5 years.
Suddenly, basal cell carcinoma went from an unrateable event to an issue that could kick you down to standard rates or worse with many companies. What these companies did was seize the bad news in a study and throw out the logical good news.
The good news in this case is that just about everyone who has skin cancer once, whether basal cell, squamous cell or melanoma, will likely become something of a fanatic about seeing the dermatologist at least annually and doing self checks way more frequently than that. That means that even if there is a slightly higher chance of melanoma, in all likelihood it would be caught early enough that it would be successfully treated.
This is where Prudential again stands out. They seem to understand the dynamics of the situation and if a person has had multiple squamous cell carcinomas or basal cell carcinomas, as long as they are checked regularly, their best rates can still apply.
Bottom line. If you have had any type of skin cancer and are shopping for life insurance, use an independent agent that knows where companies stand and know where to take your business for the best chance of success, and more importantly where not to take your business.
January 4th, 2008
Melanoma, the deadliest of the skin cancers, has been at the fore front of treatment innovation for some time. Scientists have long believed that, given a way to rev up a person’s natural immune system, melanoma could successfully be fought off without more aggressive types of intervention.
A new look at this has scientists peering through another door. Rather than trying to bolster a person’s immune system, there is some evidence that blocking T1 regulatory cells, cells that get in the way of a bodies natural defenses, may be the answer. One scientist likened the approach to permanent chemotherapy when your immune system is allowed the wage battle full time against the cancer. Chemotherapy with no side effects.
Melanoma is a particularly worrisome disease. Advanced melanoma has an average life expectancy of nine months, and less than 20% survive more than 2 years. In one study done using this new treatment, 24 of 25 patients were still living after 17 months.
Bottom line. Melanoma is a killer and anything that can be done to provide a better prognosis is bound to have an impact on life insurance underwriting. Right now melanoma is, rightly so, in the same underwriting classification as some of the other high mortality cancers. It can take as long as 10 years after successful treatment to get back to standard rates. A large swing in the survival rate could change all that.
November 12th, 2007
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