Posts filed under 'Sleep apnea'
There’s really nothing quite like it. I mean, there is snoring and then there is the snore of someone with sleep apnea, a primal snore of someone fighting for their life.
OK, so that might be a bit too far on the drama side, but the truth is that when you have sleep apnea you don’t just snore. It isn’t just air moving in and out. It’s a gasp for air with a snore attached to it and if you’ve never heard it, it can be pretty impressive.
For years the best rate class a person with sleep apnea could expect a life insurance approval at was standard or maybe standard plus. There was, and still is with most companies, a genuine concern over the health risks that can be caused by prolonged uncontrolled sleep apnea. Anyway you slice, sleep apnea is oxygen deprivation and if you spend enough time without sufficient oxygen in your blood it can cause high blood pressure, stroke and heart issues including full blown heart attack.
But that’s uncontrolled. If a person either has the apnea surgically corrected or consistently uses a cpap, the risks described above are dramatically decreased if not completely averted. That’s why, with good control, there are now several companies that will offer preferred or even preferred plus rates if all other risk factors are good.
Bottom line. Underwriting sleep apnea has come a long way in the last five years and if you have a policy in force that was issued with the old line of thinking, you might want to have an independent agent shop it for you.
March 18th, 2010
There is a tendency for people to just hold on to life insurance once it is in force, even when opportunities to improve on the rate or the term length come up. Most often this happens when their isn’t a servicing agent around to find the better deals and encourage the change.
This week I’ve provided three posts that really shout “out with the old and in the with the new”. These are opportunities that weren’t there two or three years ago so if a person in any of these situations took out a policy more than two years ago, they can likely reapply at this point and either pay less for what they have, get more for the same price, or extend the term length without paying more.
The first opportunity was for private pilots with a VFR rating. Until this past week the best they could find would have been preferred rates or, as I mentioned, ING’s preferred plus and a $.48 flat extra, which in most cases comes out slightly higher than preferred rates. Now a major term insurance player will write up to $10 million of term insurance or universal life at their best rate class if the pilot has 100+ solo hours and flies right side up from 26-150 hours a year. It’s huge.
The second opportunity came in family history underwriting where another major insurance company, in the absence of any other risk factors, will overlook a parent’s cardiovascular related death if the parent at ages 58 or 59. This opportunity may seem rather narrow but I can assure you that it could impact the rates of tens of thousands in a positive way since almost anyone whose parent died of a heart attack or stroke at those ages is currently paying standard plus rates, the third best rate class. For them a jump to the best rate class would be outstanding savings.
The third opportunity is the addition of another major player, ING Reliastar, in aggressive underwriting of sleep apnea. For a lot of years the best case with sleep apnea was a standard rate class. Now with both ING and Prudential allowing best rate underwriting for mild to moderate sleep apnea, another door is open.
Bottom line. A very small percentage of life insurance applicants get the best deal possible right from the get/go. This fact makes it imperative that your agent review annually your situation always with an eye toward improvement of the price, term length or product. Insist on it.
February 5th, 2010
We’ve leaned on Prudential for quite some time for the best underwriting on sleep apnea. Now ING Reliastar has decided they want a piece of that risk pool also.
Generally most companies will underwrite mild to moderate obstructive sleep apnea in the standard to slightly rated area. While better rates can be found, those companies that come in at standard often end up in the mix anyway because better rates require an absence of other risk factors. Commonly sleep apnea is presented along with obesity, or at least weight challenges, and high blood pressure.
Now, in the absence of other risk factors we have often received preferred plus (best rate) approvals from Prudential. Just recently we started getting the same treatment from Reliastar. If you qualify, it’s a quick way to cut your life insurance bill in half.
Comparing a West Coast Life standard rate, where they generally land with sleep apnea, a 50 year old male looking for 750,000 of 10 year term would be approved at a rate of $1570 annually. If there weren’t any other risk factors that same guy could pay $747.50 with Reliastar or $932.50 with Pru. Kind of looks like ING didn’t just become one of the players, but possible the player.
The primary reason that most companies are at standard or worse with sleep apnea is not the snoring, but the increased risk of health issues such as high blood pressure and heart attack. The carriers that approve at better rates have decided that in the absence of any sign of other issues, they are willing to accept that risk.
Bottom line. If you have mild to moderate or even severe sleep apnea and have received what you consider to be unfair life insurance rates in the past, or unfair quotes currently, seek out an independent agent that has access to the right companies.
February 4th, 2010
I was working with a client on quotes the other day and he was telling me about a friend who had decided not to even pursue life insurance because he was convinced that he was probably not insurable.
You know it’s kind of like that old saying, “The only stupid question is the one you don’t ask”. Well, the only sure way to get declined for life insurance is to just not apply. The client went on the explain in quite a bit of detail what his friend’s heart issues were and the truth was that he was, in all likelihood, insurable at a standard or maybe a slightly rated premium.
I would be the last one to claim that I can get traditional insurance for anyone that wants it. The truth is that there are folks that are only eligible for guaranteed issue life insurance. But don’t ever declare yourself uninsurable without putting in an honest effort to see what might be available. What most people find is that life insurance companies aren’t nearly as brutal as one might think.
In the recent past we have placed pleasantly surprised clients with a history of heart disease, diabetes, obesity, certain types of cancer, sleep apnea, mood disorders including bipolar disorder and people who have undergone gastric bypass surgery, angioplasty, and other heart procedures such as ablations to stop arrhythmia.
Many of these people had been declined by one or more companies before we were able to successfully get them coverage. So, don’t ever declare yourself uninsurable and don’t assume that all companies will view you the same or that all agents will know where to take your business in order to be successful.
Don’t take agents at face value. If an agent listens to your health history, especially a challenging one, and then just shoots a quote from the hip, they’re either very, very good or foolish. And I would go so far as to say that they would probably all be foolish shooting from the hip. The very, very good agents don’t want to waste your time, their time or paperwork by not getting it right the first time, so they will ask you to wait a few days while they informally shop your information and get multiple underwriting opinions. They may ask you to provide documentation to help with that process.
I routinely ask for copies of labs for diabetes, copies of stress tests for heart issues and copies of sleep studies when shopping sleep apnea cases. It’s a much better and more rewarding process when done right the first time.
Bottom line. Don’t be afraid to find out the truth about where you fit into the life insurance picture. I know I tend to make things bigger than they need to be when I don’t know where to turn for help. Seek out an independent agent who seems to truly understand your health issue, spell out your goals and do all you can to work with the agent. In most cases success will follow.
December 30th, 2009
So, you applied for life insurance and have been postponed or declined because you didn’t complete some, for instance a sleep study test your doctor recommended! Want a second opinion?
Don’t waste your time. You’ll get the same answer at the next insurance company. They want to know if you have sleep apnea also and until you either follow through with that recommended test or change doctors and actually have your new doctor provide reasons why the test wasn’t necessary in your new medical records, you’re stuck.
There is a lot being made these days about unnecessary testing. There’s plenty of it happening and a person should be able to put their foot down and say they aren’t going to take a test…..if they know that medically it is unnecessary. That’s the problem with most of us. We don’t want to take a test, usually because of cost, but we’re not doctors and we can’t factually justify why we shouldn’t take that test. It takes a doctor’s opinion to undo a doctor’s recommendation.
You can go back to the original doctor and just have a frank discussion, which you probably should have done to start with, and say, “Hey, tell me why I have to do this and what benefit I will get from me and is it really necessary, or put in my records that it isn’t necessary”. Tell them right up front that your decision not to do the recommended testing is wrecking your chances of getting life insurance so you need to know if it’s just the doctor’s want or is it really the doctor’s need.
You can also go to a new doctor, but weigh that can of worms before you open it. Starting with a new doctor isn’t cheap and it may take the new doctor a lot of testing just to bring him up to speed on where you were when the first doctor made their recommendation. And then they may recommend the same test.
Bottom line. Any time your doctor recommends anything, whether a test or a medication, if you have an issue with it, take it up with them right then and there. Don’t wait until you forget they ever said it. It’s going to be in your medical records and it will come back to bite you.
November 13th, 2009
Of course the reason snoring is a life insurance underwriting issue is because someone may put a pillow over your head and hold it there until the noise stops.
Seriously though, if that snoring is driven by sleep apnea, depending on the company you may get a brief review of your sleep studies and their best rate class or a decline from companies that requires underwriters to adhere to reinsurance manual guidelines.
Just an aside before we get into sleep apnea. I’ve mentioned reinsurance a couple of days in a row now and want to make sure people understand what reinsurance companies are and how they impact underwriting in life insurance companies.
Every company has what is called a retention limit. That limit is how much of their own money they will put at risk on any given case. For instance, if a company has a retention limit of $1,000,000 and they are underwriting a $2,000,000 policy, half of the risk will be moved to a reinsurance company. In a case like that it’s very important that a company adhere to the reinsurance guidelines in order to ensure that the second half of that risk will be bought by reinsurance.
On the other hand, if they were writing a $250,000 policy, well within their retention limit, they might be willing to be a bit more creative in their underwriting since no one else is going to need to sign off on it.
Sleep apnea is one of those health issues that can be underwritten all over the map. There truly are some health effects that, in poorly controlled sleep apnea, can have mortality impact. Probably the two most talked about are high blood pressure and heart disease, both caused by oxygen deprivation during periods of apnea.
The most common risk factor for sleep apnea is obesity, although I’ve helped plenty of skinny guys with sleep apnea get life insurance. Each risk factor also carries its’ own mortality experience which kind of adds to the complex underwriting pile.
The good news is that for those who take the sleep apnea seriously and are compliant with their prescribed treatment, if no other risk factors over ride the opportunity, can still get life insurance at preferred plus or preferred rates. This would generally be for those diagnosed as having mild to moderate apnea, but I have seen even severe apnea get the best rate when there aren’t other risk factors and compliance is excellent.
Bottom line. If you have sleep apnea and need life insurance, make sure you shop it with a knowledgeable independent agent. If you take your chances with your friendly auto and homeowners agent you probably won’t like the results. If you happen to choose an agent that doesn’t fully understand the broad range of underwriting stances, the same disappointment will likely result.
November 10th, 2009
While we’ve been very successful in placing best rate class life insurance for those with mild to moderate sleep apnea, that shouldn’t be confused with a lack of risk with the disorder.
The way to those best class rates starts with mild to moderate apnea, but needs to be accompanies by a history or compliance with treatment (yes, that means you use your cpap every night), and a lack of other risk factors such as obesity, high blood pressure or heart disease. A recent study at Johns Hopkins makes it very clear that taking sleep apnea lightly could be a fatal mistake.
The study substantiated a very definite increase in mortality risk caused primarily by the periods of low oxygen that happen during sleep disturbed by apnea. Results showed that just 11 minutes of severe sleep apnea per night where oxygen levels dipped below 90% nearly doubled the chances of premature death in men. While the increased mortality experience improved with mild to moderate sleep apnea, it still increased the risk.
Life insurance companies have been fairly steady on treatment of sleep apnea for some time with mild to moderate usually bringing standard rates and severe usually earning at least a minor table rating. Again this is in the absence of other risk factors. Prudential is the first company to really break through with better offers across the board with mild to moderate eligible for their best rate class and even severe avoiding table rating, usually approved at standard or standard plus.
Bottom line. It pays to seek out the right agent with the right knowledge and access to the right company in all situations. With sleep apnea, other companies might come close, but it would be a rare day if they beat Prudential.
August 19th, 2009
A month or so ago I talked about a client of mine who, over the course of 4 years, has been working with me to get his rate down from the very first approval we were able to get through Empire General at a table 8, to a just approved standard plus rate with Banner Life.
I hold this client up as an example of how, when a client is really involved with the process, positive things can happen. This is a guy who has provided study results, pathology reports, and gone out of his way to get a checkup that he wasn’t even due for, simply because he knew that it would help our battle to win him better rates. We were able to improve the rate each year because of his willingness to do whatever it took. His rates were over $12,000 a year. They’re now under $4,000.
In contrast are people who contact me for insurance quotes and know little or nothing about their medical situation and for sure aren’t going to call their doctor or run by the doctor’s office to get a copy of labs or a pathology report or a copy of a stress test or a sleep study. The act as if I am imposing on them to ask for more information than they can provide me right then and there when, all I’m really asking for is exactly what an underwriter needs.
If I am providing a quote for someone with diabetes, I need to know their A1c. If it’s a history of cancer I need to know the stage and grade. If it’s heart disease or if someone has had an angioplasty or bypass surgery, I need a copy of their stress test so I know what their ejection fraction is. With sleep apnea, a copy of the sleep study is needed like all of those other things, to ensure that the quote I provide is accurate.
I can’t tell you how many times I’ve heard over the years, “Well, if it’s going to be that much of a hassle, just forget it.” I always wonder if they then turn around and tell their wives that they would have bought life insurance but the agent wanted me to call my doctor’s office and it was just too much hassle.
I suppose I am beat out of some of this business by agents who don’t hassle anyone and just quote what they want to hear, or just shoot from the hip without all the facts, but the truth is that asking for that information serves two purposes in the process. First, if the client provides the requested information, it ensures an accurate quote and generally means that I can expect them to stay involved through the application process. Second, if they don’t take that small part in their own quest for life insurance, at least in my experience, they won’t end up being a cooperative client through the rest of the application and they also have a higher lapse rate than those who really get involved.
Bottom line. Not everyone gets preferred plus rates and those with serious health issues need to find a good independent agent and get involved in their own destiny if they don’t want to over pay or explain to their spouse why they are just going to go without.
May 5th, 2009
Sleep apnea is one of those health issues that can elicit anything from a best rate class approval to a decline depending on two things, which company’s underwriter was involved and if you are truly treating the issue seriously.
A layman’s sleep apnea definition might give the wrong impression of why underwriters are concerned. Apnea is actually a period during sleep when a person quits breathing. It is almost always, when they start breathing again, followed by a loud snore or gasping. Sleep apnea is not a mortality issue in the sense that people quit breathing and don’t start again. Think of it as a more severe instance like those when you have been reading or something relaxing and you just haven’t been breathing deeply, and you suddenly have the need for a good deep breath.
So the issue isn’t about whether a person will forget to start breathing or not. Our body takes care of that quite well, albeit a bit loudly. The real issues have to do with the stress put on your body by two things. First, especially in more severe apnea where a person can quit breathing up to 50 times per hour, there is an issue with a lack of oxygen during sleeping hours. The other is that sleep apnea simply disrupts normal sleep patterns and makes for a tired, sleep deprived person the next day.
So the real mortality issues become sleep deprivation and the possibility of a higher rate of accidents, and the oxygen deprivation causing high blood pressure, heart disease and stroke. The other less talked about mortality issue is that your spouse may cause you substantial harm because of your snoring.
So, what do underwriters want to see for optimal results? A good sleep study that defines the problem as mild, moderate or severe. Mild or moderate bring the best results from a rate class standpoint. Probably the biggest issue for an underwriter is what you do about the apnea and how compliant you are with whatever treatment is chosen. If you have a sleep study with a cpap on that shows the cpap reduces your instances of apnea to almost nothing, but you then only use the cpap once in a while, or half the night, compliance is poor and control isn’t good. You aren’t going to win any underwriter points. Surgically corrected obstructive sleep apnea, if success is documented by a study, can put you back into best rate class running barring any other risk factors, such as obesity.
Bottom line. There are real reasons for underwriter caution with sleep apnea, but if you are serious about your approach to treatment there’s no reason you can’t walk away paying very reasonable rates.
May 1st, 2009
Compliance and control! I haven’t beat that drum in a while, but that doesn’t change the fact that those two issues are the major underwriting issues in almost all life insurance applications where health is less than perfect.
I have used that soapbox most often pertaining to diabetes and the fact that without the two C’s, you are not going to like the rates you are approved at (best case) or the fact that you get a decline (worst case). But compliance and control weigh heavily on most health issues from high blood pressure to bipolar disorder.
Compliance could be defined as doing what it takes to stay on top of the health issue. If you have diabetes, for instance, compliance might mean that you check your glucose regularly and that you take your medication exactly as it is prescribed. There is a real tendency for people to get lax with these things and check glucose or take medications when they are having those low glucose kind of feelings. There is also a tendency to be lax about the quarterly followup visits that most doctors want to see. Having full labs done every three months is exactly the way to stay on top of your diabetes and away from all the collateral health issues that could pop up.
So, the same things that are going to positively impact your health are what the underwriters are really looking for. If obesity is an issue, a doctor monitored diet and exercise program. If sleep apnea is an issue, consistent use of a cpap machine. If skin cancer such as basal cell carcinoma is an issue, regular visits to a dermatologist is prudent and reasonable.
Bottom line. Doing the right thing pays dividends. Ignoring them carries a penalty.
April 24th, 2009
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