Posts filed under 'PSA'
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
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
Big news yesterday. Two studies that have been going on over the last 10 years threw a lot of doubt as to the value of the PSA (prostate specific antigen) test as it pertains to prostate cancer. Are the recommended annual tests going to go by the wayside and what impact, if any, will it have on life insurance?
Prostate cancer is the 2nd most common cancer among men and while, as the urban myth goes, if you live long enough you will have prostate cancer, the good news is that prostate cancer has a very high survival rate. While 1 in 6 men will be diagnosed (even though far more will live long lives undiagnosed) with prostate cancer during their life time, only 1 in 35 of those diagnosed will die from the cancer.
The early detection test of choice over the past few decades has been the PSA test. Most doctors recommend that men over 50 have the test once a year. PSA isn’t actually a test for prostate cancer, but rather a test for enlargement of the prostate. The issue that the recently completed studies has brought to the forefront is that, since the tests don’t actually tell whether there is cancer or not, and a positive result usually leads to an invasive needle biopsy which has inherent dangers of its’ own, is the test a good idea at all.
Prostate cancer, because of it’s high survival rate, is ultimately one of the most insurable cancers from a life insurance standpoint. Prostate cancer with a Gleason grade of 6 or less can bring standard or better rates as little as a year after treatment. Compared with other cancers such as colon or bladder cancer that can have, depending on stage and grade, uninsurable periods of five years or more, bladder cancer in most cases can have you back in the insurable ranks in fairly short order.
While the medical community considers whether to continue recommending the PSA test, it will remain a standard test on life insurance exams, and an elevated PSA will cause a postpone (temporary decline) until it is proven to be caused by something other than cancer. I don’t see an immediate clash coming from these differing views, there may be a point where insurance companies refuse to issue without further testing and doctors are recommending no testing. Could be interesting.
Bottom line. For now what is important is knowing that, given the outlets available to independent agents, life insurance for prostate cancer survivors is generally available and generally very affordable.
March 19th, 2009
It’s been a fascinating couple of years. I will sum it up by saying that we have helped a lot of people get life insurance who never thought they could. And what better way to celebrate the information we’ve shared and the victories we’ve had than with a shared meal, a key word salad.
Diabetes has been at the forefront of our life insurance efforts from the very start. We’ve made huge headway in finding aggressive underwriting for type 1 diabetes and type 2 diabetes. I think our strong point has been in education. There are a lot more people out there today that know what their A1c is than when we started.
I’ve been very clear about where some of the problems lie in our industry. The AARP/New York Life collaboration, on what can only be described as a sick crime against older folks, continue to offer the worst term insurance and whole life insurance in the business. They are simply not the advocate they claim to be.
I’ve stepped on some toes along the way. Selectquote and Zander Life insurance have taken exception to some of my observations. Being a Dave Ramsey fan and I think, ultimately, a reasonable person, I did apologize to Zander. In spite of Selectquote’s berating commentary, I still stand by my assertion that they are biased in what companies they offer (otherwise they wouldn’t be so easy to beat) and I still believe that Suze Orman should go back to waitressing. As to their assertion that I only use Selectquote and Suze Orman for search engine optimization, well, I don’t, even though they think I do. If I didn’t think there was better service elsewhere and more honest advertising, I would never have mentioned Selectquote.
We’ve touched on scuba diving and Prudential being a leader in great rates for recreational divers. Pru also stomps the competition on prostate cancer, sleep apnea and mild anxiety issues. While providing direction on those issues we have also been able to provide direction for those involved in skydiving and foreign travel to places where kidnap and ransom insurance is more than just a casual thought.
We’ve stayed abreast of the economic meltdown and recession that have whacked us all and tried to help people understand how best to handle their life insurance needs in these tight times.
We’ve held lengthy discussions about obesity and the impact it can have on other health issues such as hypertension or high blood pressure, cholesterol, heart disease, heart attack, stroke and cancer. We’ve discussed the risk and benefits of gastric bypass surgery as a means to avoid the life threatening side effects of being over weight.
Probably our biggest response has been from those suffering from depression and bipolar disorder. We reached a group of people that have truly been black balled in the insurance industry and we’ve been able to find some level headed underwriting and hit some major home runs for those who have the name tag but lead normal lives.
We have bared the facts behind the black eye of all black eyes in the insurance industry, the non guaranteed whole life, universal life and variable universal life policies and explained the alternatives in the permanent insurance market. There is nothing that provides greater value and peace of mind than a rock solid guarantee.
We’ve had frank discussions about business life insurance such as key man insurance and buy/sell life insurance. We did a whole series on women and life insurance. We’ve provided direction and information to private pilots that they aren’t getting anywhere else. We’ve talked about the guts of the policy when it comes to the two year suicide and incontestability clause and the accelerated death benefit and the beneficiary rights and the beneficiary issues for those who aren’t in a legal relationship such as a gay couple or an unmarried couple.
Bottom line. And the list goes on and on. We’ve tried to leave no stone unturned and no question unanswered in our quest to find life insurance for those whose mortality risk might be more challenging than average. As an independent agent it has been gratifying to have so many ways to help those who have been mishandled by the wrong agent or the wrong company. As we continue to reach out my prayer is that all who need help find it, and that more agents consider serving those who are harder to help.
March 18th, 2009
The trend never seems to end. Men especially aren’t real keen on regular checkups with their doctors and have this almost childlike view of mortality. They’re sure people get sick and die, but it’s certainly not them or anyone remotely close to their age group.
I am working with a client now who really takes denial of his own mortality very seriously. He is in his mid fifties and admitted that he had not been to a doctor in at least 25 years, somewhere in the early 80’s. For a lot of life insurance companies that by itself would be a show stopper. They don’t want anything to do with people who don’t know and don’t care about their health and over 50 and no doctor visits even for 5 years can be a problem. 25 years is a no brainer decline.
He assured me that the only reason he never goes to the doctor is that he’s never had any health issues so we applied with a company that will go up to age 60 without current medical records based on the insurance exam. Everything led me to believe, contingent on labs and exam, that he should be a preferred risk. His $250,000, 10 year term insurance policy should have a premium of around $575.
That is, of course, unless his blood pressure average on the exam is a stroke looking to happen 153/110. I was amazed that the company still made an offer rather than declining the risk until he had been seen by a doctor about the high blood pressure, but they offered a rated policy with a premium of just under $1600.
Now here’s a few pet peeves of mine all wrapped up in one neat package. All of us, whether we’re in our 20’s, 30’s, 40’s or older know someone our age who died of something completely unexpected. They were just too young! Young people don’t die from stuff like that!! It shocks us and dismays us and then we forget about it and decide that the whole thing has no bearing on our lives because it was someone else.
When you’re young, just a health fair every few years might be a good thing. When you get into your 40’s, a real physical by a real doctor would be considered a prudent thing. In your 50’s those physicals should become more regular, and regular PSA checks and yes, the dreaded colonoscopy. It really comes down to this. Would you rather be diagnosed with something early on when it is easily treatable, or when it isn’t treatable any longer, or, perhaps, during an autopsy? So pet peeve #1 is men who don’t take care of themselves when all the evidence shows it’s stupid not to.
#2 is when a guy poo pahs the whole thing even when they’ve been told they have something wrong. Mr 153/110 really didn’t see the big deal. Blood pressure totally out of control and hasn’t seen a doctor in 25 years and doesn’t see the problem. The chance that those readings were an isolated incident are slim, so the chances that he is in real health danger are a reasonable leap of assumption.
And #3 is when someone in this situation doesn’t see the logic of putting some life insurance in force because to them it’s all about price. They don’t see why ignoring their health all of their adult life would lead to a health problem that they don’t feel is worth worrying about because they don’t know anything about what healthy and unhealthy are so they don’t see why they should put life insurance in force at a higher rate because, well, why?????
Bottom line. Even if you don’t care about yourself, get a grip and understand that it matters to those who love you and those who depend on you. Suck it up and do the right thing.
February 2nd, 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
As soon as you tell someone that they don’t qualify for the best rates available, stand back, because the knee jerk reaction is to unload on you with something akin to the intelligent response, “So, they think I’m about to die of a heart attack, or what?”
First, let’s get a grip. If an insurance company thinks you are about to die they most assuredly aren’t going to offer any coverage at all, and they will probably have your agent contact you and suggest that you see your doctor sooner rather than later. I think every agent who’s been around for a while has run into a client, or a several, who has lab results come back that need immediate attention.
Just to recall a few I had a client who’s PSA on his labs was 35 and yes he did have prostate cancer but didn’t know it until it was suggested he see his doctor. I’ve had plenty of clients whose blood pressure was in the ridiculous range and they didn’t know they had a problem until we did an exam. By the way, a common theme here is that these people generally don’t get regular physicals. Another client was profoundly diabetic with an hbA1c of 11.9. After a year of treatment his diabetes was controlled enough to get the life insurance he wanted.
Mortality risk is the measure that insurance companies use to determine what rate class to approve you in, but if you don’t fall into the best mortality risk rate class it doesn’t mean that you should be saying adios to your loved ones.
Everyone is in love with the best rates available. I have long since fallen from that lofty level of health from an underwriting standpoint even though my doctor would swear to you that I’m in great shape for someone my age. All it took to bump me from preferred plus rates down to standard plus or standard was a silly thing called Raynauds. Raynauds by itself is not really a mortality issue but rather more of a pain in the rear issue. It causes my fingers and toes to change color and lose circulation when I get cold, or even just cool.
From an underwriting standpoint I have been told that Raynauds in and of itself is not a big issue except that it can be the first symptom of a larger and more deadly issue, CREST syndrome. I have addressed the issue with underwriters to the best of my ability and have not been able to convince them that while Raynauds can in fact be the first symptom of CREST, it generally doesn’t remain the first symptom for 25+ years.
Bottom line. Life insurance underwriting can’t be compared to medical evaluation. Underwriters and doctors and like men and women. They may both be good at what they do, but for the life of them they can’t figure out why the other one can’t see it their way.
November 11th, 2008
But declines happen. I’ve put together a list of the top reasons that applicants are denied coverage. We’ll start out with the first two which were covered in a post yesterday.
1. Your agent did a sloppy job. Sometimes agents slip into a habit of not wanting to ask the hard questions about your health. They just want to make you feel good, get the application and hope for the best. DECLINE!
2. You kind of don’t tell your agent the whole truth about your health, or maybe you just flat out lie in the hopes that somehow the insurance company won’t really underwrite your application. They usually do though. DECLINE!
Then there are those reasons for decline that aren’t attributable to you or me.
3. Your doctor has poo pahed some health issue and told you that, for instance, you have the heart of a 30 year old in spite of your heart attack. Doctors are famous for telling people how great they’re doing with no factual medical basis to back that up. I had a client once who was told that he was in great shape after his heart attack in spite of the fact that his ejection fraction was 25%. In layman’s terms, his heart really wasn’t pumping but rather just kind of easing the blood on down the road. Bad doctor education. DECLINE!
4. Unexpected lab results are a major reason for unexpected declines. Over the years it is amazing the number of clients we have sent off to the doctor with a declined life insurance application and a copy of their labs. Generally it shows that something has changed dramatically since the doctor last did tests, like a PSA that has elevated or it shows that maybe you should have been seeing a doctor occasionally or your cholesterol wouldn’t be in the 400 range. DECLINE!
5. Non compliance with doctor recommendations is a big one. If your doctor tells you he thinks you should have a cardiac workup and you don’t do it, no matter the reason, it won’t fly with insurance underwriters. If your doctor prescribes medication and you, not your doctor, decide that it isn’t doing what you want so you quit, again you’re grounded. If you’re not liking what your doctor tells you to do and you want life insurance, you had better find a new doctor that agrees with you or comply with your current doctor. Non compliance. DECLINE!
Bottom line. Getting approved for life insurance is a lot easier than getting declined. Think it through before you apply
October 30th, 2008
Assuming survival, which is a pretty good bet with prostate cancer, a life insurance underwriter uses a set of criteria to evaluate the mortality risk of any given cancer survivor. It is this assessed risk that is translated into a rate per thousand dollars worth of insurance that a person must pay to be covered.
Prostate cancer is the second most prevalent cancer in men with nearly 250,000 men being diagnosed each year. The good news is that only about 1 in 37 men actually die from the cancer. Since most prostate cancer is confined to the prostate gland, and the most common treatment is removal of the gland, the survival rate is very high.
Life insurance underwriters look at prostate cancer from a couple of perspectives, and each of those is given a different spin depending on treatment options chosen. Optimally, a man should be able to get standard or better rates in most cases a year after successful treatment.
Underwriters first look at the PSA (prostate specific antigen) at the time of diagnosis. It varies from company to company, but for the best underwriting the PSA at the time of diagnosis should be 10 or under. Under 4 is considered normal. A PSA higher than 10 usually indicates either a faster growing cancer or someone who has not actively monitored their PSA.
The other factor that is critical is the grade of the cancer as indicated by the Gleason score. For the best consideration the pathology report should indicate a grade of no more than 6. I’ve compared the Gleason grade to the Richter scale in the past. A Gleason grade of 6 is very insurable in most cases, a 7 only at very high rates and an 8 or above usually not at all.
So, assuming a diagnosis level PSA of less than 10 and a Gleason 6, the last factor underwriters look at is the post treatment PSA. With a radical prostatectomy, the surgical removal of the prostate, a PSA of 0 is the expected result. If after one year the PSA is still at 0, standard or better rates should be available. The other primary treatment is radioactive seed implant. Rather than removing the prostate, one or more radioactive seeds are implanted in the prostate effectively killing the cancer cells. With this treatment, since the prostate is still there, a PSA that has been at .5 or lower for at least a year is the underwriting goal.
Bottom line. Prostate cancer is highly survivable and is also very insurable in most cases. If you have had prostate cancer and are looking for life insurance, seek out a knowledgeable independent agent and come armed with the knowledge of the different factors that will be scrutinized.
August 6th, 2008
Previous Posts
