Posts filed under 'Sleep apnea'
Well, duh! Of course you do, but the good news is that you don’t have to be breathing all the time. After all, sleep apnea could be loosely described as periods of not breathing during sleep.
Sleep apnea is one of those health issues that life insurance underwriters, from company to company, vary wildly on. Some companies treat sleep apnea as if you’ll never start breathing again, instant decline. They act as if the risk is somewhere between stage 4 colon cancer and sky diving without a parachute.
On the other end of the spectrum, we have been very successful at getting best rate class approvals for people with mild to moderate sleep apnea if there aren’t any other risk factors involved. Even severe sleep apnea is getting placed at better than standard rates.
So, are underwriters really concerned that someone will stop breathing and not start again? Well, no! The truth that drives sleep apnea underwriting really revolves around the fact that during those periods of apnea, the blood oxygen level drops and sometimes blood pressure increases. These strains on the heart can lead to cardiovascular issues and possibly a heart attack.
There is also the very real risk that a spouse may strangle you because, to put it gently, there is snoring and than there is sleep apnea snoring. The difference is not subtle and with sleep apnea, especially severe sleep apnea, there is very little break from the onslaught.
Underwriting becomes more difficult when there are already risk factors involved such as obesity or high blood pressure. The more risk factors you pile on that all sort of lead in the same cardiac related direction, the tougher it is to get the best rates. In most cases though, with a good independent agent, life insurance can be found and approved.
Bottom line. As with all health issues, life insurance underwriting of sleep apnea is all about compliance with treatment, control of the problem and if you have confined the problem to just one issue.
September 30th, 2008
Probably one of the most challenging parts of life insurance is explaining to clients why their, at least to them, seemingly innocuous health issue impacts their life insurance rates. Their belief is that if it isn’t bothering them too much and their doctor hasn’t told them to buy a house close to the emergency room, what’s the big deal?
Sleep apnea is one of those issues. In most cases of obstructive sleep apnea a person would probably claim that they had overcome their only real mortality issue, that being their demise at the hands of their spouse if they didn’t do something about the snoring.
The most common risk factor (cause) of sleep apnea is obesity. While it is not uncommon in other cases, it is a relatively frequent occurrence among those who have lost control of their weight. In most cases the issues that arise from sleep apnea, snoring and sleep deprivation, are those kinds of things that fall into the “so what” category when a person is trying to wrap their mind around their own perceived life insurance risk.
The issue that very often doctors don’t talk about with their patients is the connection between sleep apnea and CAD (coronary artery disease), stroke and congestive heart failure. It is my belief that most doctors aren’t real keen on attempting to help people get a grip on lifestyle issues, so they treat the symptom and don’t discuss the underlying causative issues.
There is a definitive link between these issues, although the still unclear factor is whether sleep apnea leads to an increased risk of heart disease and stroke, or whether it is obesity that is the real culprit. Studies are ongoing to determine that answer. The other issue of congestive heart failure seems to be very clear. While sleep apnea doesn’t cause CHF, it absolutely aggravates it.
From a life insurance standpoint, while none of these cause and affect scenarios are consistent from person to person, underwriting has to consider the issues. Sleep apnea, if well controlled, is ultimately insurable at very good rates as long as it is characterized after testing as mild to moderate. Severe sleep apnea is generally still insurable, but there can be increased rates.
Bottom line. It’s not your snoring that concerns life insurance underwriters. If you have sleep apnea and need life insurance, find an independent agent who understands sleep apnea. They will know what questions to ask and most importantly, what companies will help you and what companies to avoid.
May 24th, 2008
We continue to get inquiries and continue to have success in finding affordable life insurance for people with a history of sleep apnea. This is another one of those areas where the majority of companies still have a knee jerk reaction built into their underwriting guidelines that produces either a highly rated or decline outcome.
This outcome could be appropriate in some cases of severe apnea combined with other risk factors such as morbid obesity and poorly controlled blood pressure. The problem is that the majority of companies don’t allow for the fact that there are different levels of severity and different levels of control. To put it simply, from a mortality impact standpoint there is a huge difference between poorly controlled severe sleep apnea with other risk factors, and, for lack of a better term, your garden variety well controlled mild sleep apnea with no other risk factors.
Generally speaking, from an underwriting standpoint, if the apnea is mild to moderate, well controlled by use of a cpap, and the user is compliant with use and followup, rates as good as preferred can be found. Preferred rates would obviously be contingent on the person meeting preferred guidelines in all other areas. Well controlled sleep apnea and a build of 6′0, 330#’s doesn’t get you there.
Bottom line. An independent agent should know what questions to ask and what companies to shop your business to in order to get the most bang for your life insurance buck.
May 21st, 2008
I watched a program on 60 minutes last night that reviewed the impact of gastric bypass surgery not just on obesity, but on all of the other risk factors that a person takes on when they are overweight. The results weren’t surprising, but rather affirming based on my experience of working with people who have battle obesity and won.
The stories of the eight people they interviewed were all dramatic in their own right. One lost 160 pounds, another 96 pounds, another 130 pounds and one lost 260 pounds. Incredible weight loss. All 8 of them had type 2 diabetes prior to the gastric bypass. All 8 of them are now off of medication and no longer have diabetes. Some of them had sleep apnea and now none of them do.
One of the 8 was a doctor who had always recommended gastric bypass as a measure of last resort. He now says that he believes the benefits far outweigh the risks in the morbidly obese and believes that more people should consider the surgery rather than face a life of increased risk of diabetes, heart disease and cancer.
Life insurance companies are often characterized as beating up on the overweight by offering them higher rates than those who, according to their build charts, are less of a risk. I know the feeling of being offered a higher rate than I think I deserve, but the reality is that when it comes to obesity there are so many potential collateral health issues, that companies aren’t over reacting. The best that someone who is overweight can hope for is to lock in as good a rate as they can before they have any other health issues. After getting coverage they should go about reducing the risk through weight loss whether by diet, exercise, gastric bypass or stomach banding and then reapply for a better rate. The truth is that the life insurance rate shouldn’t be the impetus to take the necessary steps. Prolonging your life should be reason enough.
Another statistic that came from the show, a rather amazing thing when you look at the long term success of diet and exercise, is that between 80 and 90% of those who have gastric bypass don’t regain the weight. And, with the procedure now done almost always laproscopically, it is much safer than in the past.
Bottom line. It should be for your own life and health, but if the reason is for better life insurance, the end result is the same. Lose the weight and your chances of serious disease go down, way down. Lose the weight and you live longer and have more fun, way more fun. Do it because it’s the right thing to do.
April 21st, 2008
Fatigue, lack of concentration and irritability. All classic symptoms of depression. Also, all classic symptoms of sleep apnea. In a New York Times article “Remedy for Sleep Apnea May Lift Depression’s Veil”, the similarity and ways to peel away the layers to a final diagnosis are discussed.
It appears this situation is a cause for mis-diagnosis in many cases. The only way to know for sure is to be tested for sleep apnea. The good news from a life insurance underwriting standpoint is that both issues, once diagnosed, treated and controlled, don’t present huge obstacles in getting competitive life insurance rates.
There are still plenty of companies out there that will cut and run from both depression and sleep apnea, but with the help of a good independent agent, you can find rates that are competitive with the best rates out there.
Bottom line. Make sure you discuss all of your symptoms with your doctor. Treatment for depression won’t do any good if the underlying health issue is sleep apnea.
January 29th, 2008
It is a rare thing in the life insurance industry when there is only one company that takes a stance completely contrary to all of the other companies. Prudential is just that bold.
For as long as there has been life insurance and cigarettes, there has been testing to determine if you have nicotine in your system. Virtually all companies assume nicotine in your system meets the underwriting threshhold for smoker rates. They bulk all nicotine use, whether it is cigarette, cigar, chew, or nicorette gum into the same rate class even though the risk factors are obviously not the same.
Prudential was one of only two companies that took exception to that line of underwriting lack of thinking. They knew that the mortality risk is not the same for a cigar smoker or someone who chews, as it is for a cigarette smoker. The other company was bought up and thrown in the trash by AXA Equitable, so 50% of the common sense in the life insurance business left us last year. That was bad news.
The good news is that it doesn’t appear that Prudential is prone to being gobbled up by some other company and they seem very solid in their stance on this issue.
There are very few companies that will break away from conventional underwriting, but Pru, the Rock, seems to do it consistently. They have the best underwriting when it comes to sleep apnea, mood disorders including bipolar disorder, prostate cancer, student pilots and……..cigars.
Bottom line. As all the other companies languish in mediocrity, Pru stays on the cutting edge. I believe they are one of the only companies that cares about underwriting reality, not letting a book dictate their decisions.
December 14th, 2007
Over the years, North American Ccmpany for Life and Health has moved in and out of the impaired risk spot light. Overall though, they would have to be judged as one of the better small companies out there.
North American isn’t one of the big boys, but they are still here after 120+ years and there is something to be said for not going away. Having said that, there is a pretty significant rumor milling around that Midland National and North American will be merging soon. Attached is a summary of ratings and stats on both companies.
north-american.pdf
midland-national.pdf
North American has proven to be consistently formidable with the private pilot market. Other companies come and go, but North American has been steady there for years. They also underwrite toward the top of the stack on strokes and some cardiac issues.
In recent history they were leaders in the industry in underwriting type 2 diabetes and cancer, but have become more conservative on that in the past year or so. They have also taken a step backwards on sleep apnea. They are pretty middle of the road on these issues at this point. We are in the process of finding out what direction they will take if they do merge with Midland.
In my memory they have never been good with type 1 diabetes, multiple impairments such as diabetes and heart disease combined, or foreign travel.
Bottom line. One of the reasons that independent agents can be a valuable partner in your search for life insurance is that when a company changes their view on a certain impairment, we’re not stuck there. The winds are always shifting and flexibility is a good thing.
October 19th, 2007
The Rock!! I bring Pru up every once in a while simply because they seem to be a company that is out to make a difference in the life insurance business. Other companies are competitive, and Prudential isn’t the answer to every life insurance question, but they are trying as hard as any company out there to expand the underwriting box and be just a little more fair. The attached is a two page summary of Prudential Financial’s rating, history and financial strength.
prudential.pdf
So, what are their strengths and what are their weaknesses? They are above average in underwriting for private pilots (including students), sleep apnea, weight (with an extra break if you’re over 65), situational anxiety and depression issues if well controlled, one time dui cases, prostate cancer and family history.
Areas where they come close, but I personally would like to see them be a little more aggressive would be well controlled diabetes and minor cardiac issues (a one vessel angioplasty with no heart attack after age 50).
Where I really wonder what they are thinking is with more involved heart issues and cancer (except prostate cancer).
But, no company can be all things to all people and again, they are a cut well above average in today’s market.
Bottom line. It takes an independent agent to figure out which direction you need to go for the best life insurance value. All of the top companies have an area where they stand out. Pru has several.
October 16th, 2007
There may be more than one reason to be upbeat about sleep apnea from a life insurance standpoint. As I’ve mentioned in previous posts, there are offers coming in on life insurance for those with mild to moderate, well controlled sleep apnea that can be as good as the best rates out there, as long as all other risk factors are under control.
If your sleep apnea fits into that scenario, you might also be doing your heart a favor. A recent study showed that control of sleep apnea through committed use of a cpap can be beneficial in holding atherosclerosis (hardening of the arteries) at bay, or even reversing early signs of the disease.
This is sounding like a win/win situation to me. Two of the collateral issues that have always led underwriters to take a serious stance on sleep apnea are high blood pressure and atherosclerosis. Good control on one helps avoid the other two. Good for your health and great for life insurance rates.
Bottom line. Whether it is sleep apnea or diabetes, compliance with recommended treatment leads to good control, which leads to better health and less complications. Hard to find a downside to that!
October 16th, 2007
At least there are a few good things about sleep apnea. First, who needs a doctor when your spouse can diagnosis it for you? Second, and a little more seriously, once diagnosed it is very treatable.
Sleep apnea is a challenging underwriting task for life insurance. Like health issues such as type 2 diabetes, the actual disease or problem may not carry that high a mortality risk, but when combined with all the collateral health issues it becomes much more complicated.
Take for instance the fact that a person with sleep apnea is four times more likely to have a stroke. About half of all people with sleep apnea also suffer from high blood pressure. Most men with sleep apnea have been beaten by their wives on multiple occasions until they have agreed to see a doctor.
Bottom line. Life insurance is all about determining mortality risk. When sleep apnea is out of control the mortality risk is substantially elevated due to collateral issues. When it is well controlled, providing all other risk factors are good, preferred rates are not out of the question.
September 26th, 2007
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