Posts filed under 'prostate cancer'
Not a week goes that I am not called by someone with a history of cancer. It can be as common and treatable as prostate cancer or breast cancer, or as unpredictable as multiple myeloma. They would like to have life insurance, just like anyone, but insurance quotes take more information and leg work than if your health issue was high cholesterol.
Unless a client has saved all of the reports and paperwork, it often means going back to doctors and asking for the information. But let me be real clear about this, there is no way that I, or any other agent or agency out there, can accurately quote life insurance with a history of cancer without the pathology. The only exception to that hard and fast rule would be a history of basal cell carcinoma, the most common and least deadly of all cancers.
So, when someone says they had breast cancer or prostate cancer, the next question coming from me is, “do you remember the stage and grade of the cancer?” Most of the time the answer is no. They might remember that it was an early stage or a low grade but those terms are about as generic and useless as they sound. Those are the things oncologists say because frankly they don’t want the patient burdened with details that they won’t understand.
Personally I think having that information allows a person to truly educate themselves on what they are facing and what their options are. Knowing the actual pathology opens the door to enlisting 2nd opinions. With all of the information available on the internet it also gives you the information needed to know if you would have other treatment options available.
From a life insurance underwriting standpoint, no matter what type of cancer you had, the earlier the stage and the lower the grade the better, but in order to shop it those have to be actual values and not just lower and better. An example might, simply stated, be a stage 1, grade 1 cancer. With breast cancer a stage 1 tumor measures less than 2cm/1in. Stage 0 would be an insitu, or fully encapsulated tumor. The lymph nodes in the armpit are not affected and there are no signs that the cancer has spread elsewhere in the body. A grade 1 breast cancer means that the cancer cells look very like the normal cells of the breast. They are usually slow growing and are less likely to spread.
Pathology is the key to the rating of the policy. It means, in most cases that clients will need to make a call or go by the oncologist’s office to get a copy of the pathology report. It’s not a big deal and shouldn’t require an appointment or cost anything. If you have paperwork from your cancer treatment stored, check and see if the pathology report is mixed in with that.
Find an independent agent, preferably one knowledgeable enough to know that you needed that report, and review the entire history from diagnosis through treatment to recovery and cure. Not all cancers are created equal, so stay open to what you will hear from the agent. It might be a good quote and it might be information on how long you will have to wait before you can get offers on life insurance.
Bottom line. Many types of cancer are insurable at very affordable rates within a short period after the end of treatment, so do the home work and Google your type of cancer and life insurance. Try to pick through and find truly independent agents who stand out as having a good understanding of how to get you from point A to approval.
March 12th, 2010
I’ve often heard and read several places that most men will get prostate cancer to some degree if they live to a moderately old age. The good news is that, for many, it will have little or no impact on their lives or their mortality. For a great many they will, as the theory goes, never know they had it and it won’t be the cause of their death.
Prostate cancer that is slow growing, that is to say a low stage and grade, is quite often not treated in older men, but rather just monitored. This is known in the medical and insurance circles as watchful waiting. I polled a number of very good life insurance underwriters and was told that watchful waiting is not considered a treatment by them, and with all of them a client would be declined until an active and measurable treatment is completed. It is the medical stance that if the cancer ever does become more aggressive or dangerous then treatment can start and because it will be caught early in its’ aggressiveness, the treatment would likely be successful.
But let’s talk about the rest of us guys. There really is good news when it comes to prostate cancer and life insurance for the majority of cancer survivors. Especially if you get annual checkups (health fairs are great for this) prostate cancer can often be detected while the war is still very much winnable.
If a prostate cancer is a stage T1 or T2, and a Gleason grade of no more than six (this is the majority of cases), and the PSA at the time of diagnosis was less than 10 (this again is the majority of cases) better than standard rates should be attainable within a year after a prostatectomy and within two years after a radioactive seed implant. The underwriting guideline at that point would be that if they took the prostate out, your psa needs to be 0, and if they did a seed implant it needs to be .5 or less.
When you start talking about better than standard rates after most other types of cancer, that is not the norm. Getting those rates within a year or two would be completely unheard of with other types of cancer. Early detection is the key. A small price to pay for protecting your life, let alone your ability to purchase affordable life insurance.
Bottom line. Guys aren’t exactly known for our proactive approach to health. We may exercise and eat right, but actually going to the doctor on a regular basis and having labs or even, dare I say it, a digital exam of our prostate, well, that’s just not normal.
March 11th, 2010
We’ve covered a lot in the past on the life insurance underwriting of prostate cancer. Prostate cancer is one of those good news/bad news events in the cancer world.
Prostate cancer is the second most prevalent cancer among men, surpassed only by skin cancer. It also has the distinction of being a very survivable cancer in most cases. Because of the high survival rates, it also has the distinction, within certain boundaries, as being a very insurable cancer once treatment has been successfully completed.
First let me review what would be presented as an optimal case for underwriting and then I’d like to share a few things that will drive underwriters in the opposite direction.
Prostate cancer stage and grade are two key factors. The grade, sometimes called the Gleason score, is on a scale from 1-10. Optimally, for standard or better rates, the Gleason score should be 6 or less. 7 becomes problematic and above that is rarely insurable. Combined with a low stage 1 or 2, that’s half the battle.
The other half of the battle is what was your PSA at the time of diagnosis and what is your PSA post treatment. Again, optimally your PSA should be 10 or less at the time of diagnosis and if the treatment is a radical prostatectomy, it should be a statistical 0 afterward. With a radioactive seed implant therapy the PSA can be as high as .5 post treatment.
So, what kinds of things can ruin the chances of a good approval? I am working a current case that highlights one of not more of those. First, the client had a PSA over 21 at the time of diagnosis. The pathology showed a Gleason score of 7 and a stage of 3. He had a radical prostatectomy and as would be expected his PSA vanished post treatment. The killer. Two years later his PSA returned and climbed almost to 1.0. In the absence of a prostate, the underwriter has to assume that some cancer was missed and it is coming back.
In this case he then had radiation treatment and it, over the course of a year, drove the PSA back down to where it should have been. But worrisome to the underwriter is where the new cancer came from and is there more than has gone undetected.
Bottom line. There is no such thing as a shoe in approval when dealing with cancer, but success on prostate cancer is pretty common. Just make sure when presenting your request to an independent agent that you know the numbers. Stage and grade and diagnosis and post treatment PSA levels.
January 13th, 2010
Prostate cancer has been on of those life insurance health issues that we’ve been able to help a lot with over the years. Like so many other issues it can be an instant decline with a lot of companies and we can shop it and get better than standard offers.
Recently I wrote about a customer who had called in asking about life insurance. During our discussion I asked about the Gleason grade of the cancer and it was a 9. From previous posts you might remember that a Gleason 6 or below is pretty easily tackled and standard or better rates are often available. A Gleason 7 is tougher but as long as the stage is low, it can be done at times as a mildly rated policy. A Gleason 8 or above has been pretty much a strike out with most companies on a trial giving the stock, “prefer not to offer”.
The Gleason 9 was no exception. But among all the lumps of coal was a surprise gem, an offer from Principal Life. It wasn’t a great offer, but neither the client or me truly expected anything at all so we were surprised and pleased. Their offer was a standard rate and $15.00 per thousand flat extra for 5 years.
I know I’ve covered this before, but a flat extra for a certain period like the proposed 5 years is a way for a company to sort of pad their willingness to accept risk. So, in this case they are essentially saying that they consider this case to be more risky during the first five years and for $15 per thousand dollars of insurance per year for five years they are willing to accept that mortality risk.
To pull that all into perspective, the client wanted $250,000 so the flat extra (250 x $15 = $3750) is $3750 per year for five years. They said they would approve at a standard rate. In this case the $250,000 of term insurance at a standard rate was $4600 annually. So for the first five years the total premium would be $8350. Starting in the 6th year the flat extra would go away and the premium would be $4600 for the remainder of the term.
No one said it would be inexpensive, but then no one said it would be doable at all.
Bottom line. We found this offer on our third round of trial requests. It pays to have an independent agent who is willing to look where others won’t and try where others say it can’t be done.
November 5th, 2009
I got a call from a prospective client last week wanting to see if I could find anyone who would offer him life insurance.
His issue is prostate cancer with a Gleason 9. He had a radical prostatectomy, chemotherapy and is currently on hormone therapy Lupron. His PSA has been undetectable for a year and a half. While we certainly haven’t had much luck with a Gleason grade greater than 7, I told him I would shop it and see. One thing about this business is you really never know.
I got the first round of responses in yesterday and for the most part they were the typical “No way” answers that the reinsurance manuals would lead them to. No harm. No foul. There are companies that will not deviate from reinsurance guidelines even when the death benefit is within their retention limit. I think it’s kind of woosy, but I’m not their CEO so what can I do.
I did get two interesting responses though. Western Reserve Life said no for now but that they would consider coverage December 2010. I suspect at that time it would come, if they approved it, with a substantial flat extra, but that’s OK. We’ll keep that one bookmarked. The other was Lincoln Financial who said they would consider coverage once he was not on Lupron. That may or may not work because we don’t know if Lupron will go on for the rest of his life or not, but again it was not an absolute no.
Generally prostate cancer with a Gleason grade 6 or less is not a big issue as long as the treatment has brought the PSA down to essentially 0 with a radical prostatectomy and less than 0.5 if the treatment was seed implant. Approval at standard or standard plus is a target that can generally be hit. Even a Gleason 7, depending on the stage of the cancer is generally not insurmountable in the life insurance search. A Gleason 7 would probably be a rated policy, higher than standard rates.
But Gleason 8 and above is indicative of a fairly aggressive cancer. I have reached out to more companies on behalf of this client and will post all of the results by each company once they all respond.
Bottom line. Prostate cancer is the second most common cancer amongst men but with early detection and treatment, it is a very survivable cancer.
October 29th, 2009
I heard through another agent this morning about a 68 year old client of theirs who was declined by Banner Life due to his PSA increasing from 2.1 to 3.1 over the last 15 months.
It must be really dark where that underwriter keeps their head. If the client was young that might be cause maybe for a postpone to get a checkup with a urologist, but old guys have several reasons to be cut some slack on the PSA issue. First and foremost is that almost all guys in their late 60’s have an increasing PSA. A large percentage suffer from BPH, benign prostatic hypertrophy, enlargement of the prostate, and this drives the PSA up. Prostatitis becomes more common and that drives the PSA up. And, there is always the chance that a guy has prostate cancer and that would increase the PSA.
While the word cancer might send some into a dizzying downward spiral, everything I have studied would suggest 1. That a change in PSA from 2.1 to 3.1 in 15 months shouldn’t be alarming at age 68 because at worst it might point to a low grade prostate cancer and 2. low grade prostate cancer at age 68 is, in the whole scheme of things at that age, hardly a mortality risk.
The other issue with that small an increase in PSA with both readings falling well within the normal range, is that the PSA test is known for its’ ability to be enormously inconsistent. One study showed that when testing was done 3 times over a 90 day period 46% remained pretty constant, 33% had changes of 1% and the largest changes were an increase of 7.5 and a decrease of 5.3.
So the accuracy or at least consistency of the test is at least not the quality that an underwriter should want. It certainly begs to wonder why anyone, underwriter, doctor or Fedex driver would jump to any conclusion based on two readings 15 months apart. It isn’t a well spent leap of assumption.
Bottom line. Banner has been acting a bit rudderless lately and this type of decision is indicative of that more than what a client or agent should expect.
September 24th, 2009
A person contacted me a few months back looking for a policy to replace his current universal life which is going up in price on every anniversary date. He has been paying on the UL for about 15 years and just two years ago he received notice that the policy no longer had sufficient cash value to support the death benefit. He either needed to lower the death benefit or pay a significantly larger premium if he wanted to keep it in force.
The first time this happened he assumed it was a one time adjustment and he paid the extra premium to keep the policy in force. This year brought another large adjustment. It was now at a point where he couldn’t afford the coverage. He called me because he needed a policy at a rate he could afford, he needed that rate to be guaranteed to be level, and he had a history of prostate cancer.
We shopped the case and in spite of his Gleason grade 7 prostate cancer we were able to get a trial offer of standard from Lincoln National on a term insurance policy. The 10 year term fit well with his plans as he will be retired by then and his assets will allow him to self insure. All of the other companies offered either very highly rated policies or a decline so he indicated that he wanted to move ahead with Lincoln National. But he wasn’t quite ready. He still had a few months left on his UL that was paid for and he didn’t want to pay for double coverage. I encouraged him, in spite of the extra cost of double coverage, to take advantage of the Lincoln National offer sooner rather than later.
The next time we talked he was calling from the hospital. He had blood clots in his lungs, likely caused by a seasonal asthma that his doctor treated with prednisone. He is now on coumadin to prevent any further clotting, but Lincoln National now wants to put him off another 6 months so they can be assured that the clotting issue is under control.
So he is trapped by the universal life policy with another price increase on the way and unable to switch due to essentially being uninsurable for the next six months. I wonder what the long gone insurance agent that sold him that UL based on nothing more than assumptions would say to him today. How can an agent look someone in the face and explain what he had done to them so many years before based on the assumption that the economy would always be just peachy? The answer is they don’t. Those agents that do what his did have a way of disappearing when things turn sour.
I have encouraged the client to keep his policy in force on a monthly basis to minimize the out of pocket disaster and Lincoln has indicated that if everything is OK with the blood clots they will be willing to entertain a new application in November.
Bottom line. If you have a universal life or whole life policy that has a surprise price increase, move immediately to do something different. Almost without exception, once a policy jumps in price it will continue to do so at each opportunity the company has. And, if you have a good offer, don’t put it off until your old policy comes to another due date. Things can and will change.
May 20th, 2009
When I got my briefs in a bunch earlier this year in a little spat with ING Reliastar, on the surface it would seem that we were arguing semantics. Just underneath the surface is a gray area about half the size of the universe where life insurance companies seem to make underwriting decisions just because they can, and because it makes more money for the company. In their mind there is no overriding need for logic.
And I scream, “Show me the mortality risk”!!!!! Back in the day (been wanting to say that) I distinctly remember being taught as a new agent that underwriting decisions were based on mortality tables and mortality experience. Forgive me, but there is no stinking difference in mortality experience that anyone can show me between a cholesterol ratio of 5.0 and 5.1. In this particular instance we were fussing about a guy whose total cholesterol was 253. His HDL was 49.6 and they said it needed to be 50.6 in order to get preferred rather than one rate class difference. That one rate class change would have made his premium 30% higher. Show me the 30% higher mortality risk!!!
I realize that there have to be lines drawn in the sand. There are readings that can change a little and truly do have a noticeable, dramatic mortality experience impact. Someone with prostate cancer whose grade was a Gleason 6 can get good rates on life insurance and a Gleason 7 is scratching to get any offers at all. That’s because the difference between those two grades is like the difference between an earthquake Richter scale 6 or a 7. One shakes you up and the other knocks your house down.
I have never been one to fuss with underwriters when they have a legitimate reason for changing a rate. I can handle the fact that they have guidelines that they need to follow, but when they call them guidelines and to the detriment of common sense, they treat them as hard and fast, set in concrete rules, we have a problem. This may just be the world according to Ed, but if a company can’t show the difference in mortality experience between their “guideline” and, for instance, a specific lab result, the default should go to common sense.
Several states have already force companies to take this approach when it comes to foreign travel. Unless a company is willing to supply mortality experience that shows travel to a certain destination is an additional risk, they can’t decline or rate someone for that travel. Some states have even taken the stance that absent mortality tables for foreign travel, a company can’t even ask about foreign travel.
Bottom line. While I do occasionally fuss, the truth is that most life insurance underwriters are willing to give a fair hearing and make a fair decision, but for those that won’t or don’t, again I scream, “Show me the mortality risk”.
April 29th, 2009
It seems to me of all the major cancers, being the second most common among men, prostate cancer has been a hot bed of breakthroughs and I believe (the world according to Ed) will be the first major cancer that will be rendered null by scientific research.
Today more good news came to the subject. It turns out that a common prescription medicine for treating an enlarged prostate, and a major supporter of some of my favorite TV shows, Avodart, has shown great results in keeping prostate cancer at bay.
With prostate cancer already being one of the most insurable post treatment cancers, knocking a quarter of the cases completely out of the loop can be deemed as nothing short of great news. The way I see it is the lower the risk of getting the cancer, the better the mortality experience and ultimately the lower the life insurance rates.
Just to recap some of the criteria that lead to the best possible, standard or better, rates with a history of prostate cancer, they begin with a diagnosis level PSA of 10 or less. One of the most important factors is the grade of the cancer and for the best rates it should be a Gleason grade 6 or lower. Depending on the treatment, with a prostatectomy the post treatment PSA should be 0. With a seed implant a stable reading below .5 is the benchmark.
Bottom line. Any day there is good news about any cancer is, well, a very good day indeed.
April 27th, 2009
I had a client who was just declined due to lab results on his insurance exam. This took us both by surprise since he had indicated that he had a physical just 6 months ago and his doctor had told him everything was fine.
Unfortunately, because he told me that that everything was fine I didn’t see a need to see the set of labs before we applied. Now “in retrospect” has hit us both in the rear. When I called today to tell him about the decline which was due to an elevated PSA and an elevated A1c, we had a chance to discuss those two issues and he remembered that the doctor did make mention of both of those, but dismissed them as irrelevant.
The doctor actually retested the PSA after he got an initial high reading and informed my client that the second reading was high also, but not high enough to worry about. An elevated PSA is indicative of either an enlarged prostate or prostate cancer. I’m no doctor, but it seems to me that it might be a prudent exercise on behalf of the patient to do some testing and determine which of those two is increasing their PSA.
The elevated hbA1c was at 8.2, which means his average glucose levels are in the 180 range. He said his wife has type 2 diabetes and he has messed around checking his glucose occasionally and it is usually in the 120-130 range. So if his lows are around 120 and his average is around 180, there are plenty of 240+ levels happening in his life. His doctor’s take on the elevated A1c…..he really doesn’t believe in it!!!
My client, now armed with the labs from his insurance exam, is seeking a second opinion. We have some work to do before he will be ready to apply for life insurance again, but I suspect we’ll be back after it in six months to a year.
Bottom line. Learn to question things that don’t add up with your doctor. Like, “Doctor Smith, if you tested my PSA twice and it was out of the normal range both times, why is it that I shouldn’t worry about that? Can you show me some documentation telling me why that goes in the don’t worry column?” And, “Dr Smith, if you really don’t believe in the hbA1c test, why did you have it run?”
April 6th, 2009
Previous Posts
