Posts filed under 'Type 2 diabetes'
When I was helping out after Hurricane Rita in Mississippi, I got to experience, first hand, southern hospitality and also the gateway to obesity, down home southern cooking. The only thing that saved me from coming back from that trip 25 pounds heavier was the fact that this high altitude, low humidity Colorado guy was sweating from daylight to dark as we cut trees off the tops of people’s houses.
I don’t think you’ll find many from the south that will argue that the staple of southern diets, fried food, is a sure way to stay slim and trim. With the top three states in this years obesity survey being, in order, Mississippi, Alabama and Tennessee, you have a cultural cross section of the country that is all about family, friends and meals. I’m not saying that it’s like they are just out to get fat. Rather it seems more that eating is a form of community and fellowship.
Anyway, before I stray off and tick off everyone in the south, the point is that while the weight issue is more prevalent in the south, there is actually only one state where less than 20% of the population isn’t obese according to the body mass index and that is Colorado. And I don’t mention that because I live in Colorado, but because we all live in an absurdly overweight country.
Does it seem to anyone that having 30% of your state’s population over the standard for obesity is a healthy thing? From a health and life insurance standpoint it is a recipe for disaster. Chronic obesity throws the door wide open to the other great epidemic of the last 10 years, type 2 diabetes. Sure, these things are survivable and sure, you might still be able to get life insurance, but where is the quality of life and where is the affordable life insurance.
Bottom line. Studies have shown that losing weight can reduce the risk of numerous health conditions and even reverse, or cure, type 2 diabetes. Sometimes I think I come off a little too preachy, but let’s be real. Obesity can be reversed. You can change your diet and your life style. We can bring our country back from the brink of eating ourselves to death, for us, and for our children.
July 22nd, 2008
For just about any health issue there is a “sweet spot” for life insurance underwriting, that place where all of the pluses overcome the minuses and a better than usual approval is received. This is especially true of underwriting guidelines for type 2 diabetes and the good news is that with current treatment options it is possible to shoot for and reach the thresholds that bring lower insurance prices.
With diabetes underwriters are looking for those people who accept that they have it but aren’t willing to let it get a hold on their medical future. A lax attitude toward diabetes can lead to complications and collateral health issues, none of which paint a pretty picture for the years to come.
To start with, early onset type 2 diabetes is a problem. Most type 2 can be traced back to life style issues with obesity being the number one culprit. If a person, due to poor life style choices, has diabetes starting in their 20’s-40’s, convincing an underwriter that you present a good life insurance risk is going to be very hard. The first sweet spot in underwriting type 2 diabetes is onset after age 50 and not linked to morbid obesity.
The underwriters want to see compliance with your doctor. Do you take seriously your doctor’s recommendations to lose weight, exercise and change diet? Do you take your medications and check your glucose regularly? Have you done any diabetes education classes? Do you know what an hbA1c is and do you know what your’s is?
Underwriters want to see control. They don’t care if you can fast and get a glucose reading of 98. They want to see that you hbA1c is less than 6.5 which would indicate that your glucose levels have been consistently in a controlled range for the past three months.
And last, but by no means least, to get the best rates you can’t have other risk factors such as eye sight, high blood pressure, kidney problems or coronary artery disease (CAD).
Bottom line. The sweet spot for diabetes underwriting is all about late onset and good compliance, education and control.
June 16th, 2008
I have written in the past about life insurance underwriting on type 2 diabetes and also on heart disease. I think I have been very clear about the fact that life insurance underwriters are adamant about good control of diabetes and also we’ve discussed the problematic underwriting of the combination of diabetes and heart disease.
We’ll see where current studies guide diabetics and how underwriters react, but one recent studysuggests that type 2 diabetes, well controlled or not, results in a high occurrence of heart disease.
Heart attacks and strokes are the leading cause of death among type 2 diabetics and the ADA suggests that the rate of death among diabetics due to heart disease is possibly as high as 75%.
All of that is to say that perhaps life insurance underwriters are putting to much emphasis on driving glucose numbers down, possibly putting too high an emphasis on a low hbA1c. Current studies would indicate that may be the case, but don’t look for underwriters to jump on the bandwagon until more conclusive results are brought forward to back up the initial findings. I can see any changes going one or two ways. They may become less stringent about glucose levels, but may adjust mortality tables to reflect the high occurrence of heart disease in diabetics.
Currently the most critical underwriting factors for diabetes are age of onset, level of control as measured by the hbA1c, and any complications that have manifested themselves due to the diabetes such as neuropathy, retinopathy and heart disease. The best underwriting and rates would go to late onset (after age 50), an hbA1c of 6.5 or under and no complications.
Bottom line. The studies throw out some pretty sobering news and also, I think, some very useful news for those who have been battling to drive down their glucose levels. I’ll keep you posted as to any changes we see in underwriting guidelines, but as I said, I suspect those changes will be slow in coming.
June 7th, 2008
Everyone believes they should get the preferred plus rates that are advertised everywhere. “Di you know that John can have $500,000 of term life insurance for just $12 per month?”. The truth is that many qualify for those rates and get them, but for the average person with average health issues, we don’t.
Probably the quickest group to rebuff anything but a best rate approval on life insurance are those folks that are overweight and know they’re overweight, but simply don’t see it as an issue. It has been my experience that this group, more than any other, seems to have a firmer grasp on denial than most. They, inspite of knowing the link between obesity and other health issues, don’t believe it is fair for them to be charged more for life insurance than someone who is fit and taking care of themselves.
Now let me be clear about this. Using a body mass index calculator I appear to fall into the overweight category at 5′10 and 175#’s. But insurance companies aren’t abusive about the build issue. With most companies, even though I am clearly in the overweight category, would actually allow another 20#’s or so before they would bump me out of the best rates as long as I didn’t have any other health issues that would preclude that.
Having said that, 5′10, 220#’s is going to catch the prize with any company. They aren’t going to care if that is the same weight that you played football at in high school. They aren’t going to care if you work out five times a week or run five miles a day. They aren’t going to care if your health is perfect in all other aspects. Obesity is obesity and along with it comes substantially increased risk of health issues that have the ability to shorten your life span and assessing your mortality risk is what life insurance underwriters do.
So, the folks whose weight (or lack of height) doesn’t get them what they want, in general, will blow off whoever is honest enough to tell them what insurance will really cost, and go on to another agent. Many are apparently so offended, in my experience, by honesty that they will never return a call again. It’s as if I called them fat or ugly or something, when all I really did was gave them an accurate quote. To them, possibly it feels as though I am just one more person in their lives who is treating them unfairly.
I don’t know what is going through their minds really, because they don’t call back to discuss it.
The truth is that the rates are fair based on build and that evenly the morbidly obese can put together a plan of life insurance that should fit into their budget. The challenge is to get over the fact that weight is an issue and it’s not going to change and work with your independent agent to find the company and the plan that will work best for you. There is not a cookie cutter interpretation of the weight issue from company to company and there are good rates to be found.
Bottom line. With obesity ranking high among the leading causes of type 2 diabetes, heart disease and cancer, underwriters can’t afford to ignore weight. Even if those health issues are currently present, you are at a greater risk than the average sized person of coming face to face with one, or more of them.
June 5th, 2008
In my last post I hope I made a clear distinction between a life insurance agent who is qualified to handle cases that involve health issues, and those who really shouldn’t play with sharp objects. At the end I alluded to the definitive way to separate the two groups.
First let me broach the subject of bait and switch. Baiting, telling the client that they qualify for a rate that they don’t, is a way to get the application. Getting the application is a way to get anyone who told you the truth out of the picture. Let’s say I quote you $1200 a year for a term insurance policy. I’ve presented my quote based on the fact that I know you have type 2 diabetes that was diagnosed at age 51 and we reviewed your last set of labs and I know that your hbA1c was 6.4. Another agent quotes you the same policy for $800 a year. Most people will jump on the less expensive band wagon and won’t even talk to me again.
The switch is when the policy is approved. Generally, because a bait and switcher just goes with their favorite company (where they get the highest commission), the approved rate will come back even higher than what I quoted. The B&Ser will come up with some song and dance about why the rate changed and then, having just drug you through a 2-3 month application process, suggest that unless you want to start over and take your chances, this is really as good as it is likely to get.
I know you’re all sitting there saying that you wouldn’t fall for that, but the truth is that bait and switch is alive and well because most of you will accept the higher priced policy rather than start over.
You sound mean, but you’re not.
Which brings me to the magic bullet. How can you weed out the B&Ser right up front? How can you tell if they’re telling the truth or just low balling a quote to capture the application? The bullet is called a trial offer. They way trial offers work is that, for instance, I would send an email out anonymously to the underwriters from all the companies I represent. The email might go something like this:
Proposed insured born 3/14/53, 5′10, 175, non smoker. Diagnosed 4 years ago type 2 diabetes. Most recent a1c 6.4. No other risk factors. All other labs normal. Good family history. Takes 500mg Metformin daily. Looking for $500k term insurance.
Insurance underwriters respond, always with the caveat that any final offer is subject to an exam and a review of medical records. There offers, and these are actual insurance company responses, come back like this. “Tentative ok without a rating if fructosamine is normal”, “Very tentative Standard No Nicotine subject to app,exam,labs,EKG and APS (attending physician statement)”, “Our tentative quote is Standard (due to glucose)”. Once received, we know which company will ultimately provide the best approved offer.
So here is the way to ferret out the bait and switch agent. If you are shopping for insurance and you have health issues, and one quote comes back significantly lower, insist that they provide you with a copy of the trial offer from the company they are quoting. If they don’t have one, they don’t know what they are doing. If they try to tell you that they don’t need one or that companies don’t really honor trial offers, they don’t know what they’re doing. And ultimately, if you think there is some chance that they might come through, apply with them and also apply with an agent who can produce a trial offer, and do it concurrently. Simply let the agents know that it is your intention to accept the best offer after underwriting. That’s fair. Smart too.
Bottom line. The life insurance industry has it’s share of slime balls and their favorite sport is bait and switch. You now have the ultimate weapon for stopping them before they can get you to join their game. Do you want a low quote or an honest quote? Do you want the policy to be approved with no surprises? Do you want to deal with an honest life insurance agent? You decide the game you’re going to play.
May 28th, 2008
There must be a couple of million people in the US licensed to sell life insurance. If you take in the giant internet mega agencies, all of the independent agents, and all of the captive agents (work for just one company), the possibilities for purchasing life insurance become staggering.
Put in context, there are probably as many, if not more doctors. Does that mean that no matter what is wrong with you, there are 2 million choices for a place to go for treatment? I’m thinking not. If you have a cold, a cardiologist is likely not going to see you, and if you’ve had a heart attack, it’s highly unlikely that your general practitioner won’t refer you to a specialist. There are those unfortunate times when GP’s think they know the answer to everything and attempt to treat serious illness in house, but those are rare.
Life insurance is one of those areas where the millions of choices doesn’t mean you have millions of appropriate choices. For the average very healthy person under 50 probably any independent agent or agency can do a good job of finding a low rate with a good company. As I’ve mentioned before, young healthy buyer beware though. Even though the mega agencies on the internet can find competitive rates, they have a bad habit of signing lucrative bonus contracts to push the bulk of their business toward a certain company. The good news is that the company is generally competitive. The bad news is that, as I’ve noted in so many previous posts, competitive doesn’t mean best. An independent agent doesn’t do the volume and therefore we are never offered these type of contracts. Speaking for myself, I place every case with the best possible price and product for my client. Seems like the right thing to do.
One other note on our perfect health client. Stay away from your auto and homeowner’s agents. You will be outrageously overcharged for life insurance because it isn’t what they do. Sure, they have a product and they are licensed, but having a license doesn’t mean you know what you’re doing and having a product doesn’t mean the price isn’t way too high.
But I want to make a very important distinction. Just like the doctor scenario, if you have some medical issue, a knowledgeable independent agent is where you want to go. We are the specialists in the life insurance business. Just a quick list of what I am talking about will help separate the GP’s from the specialists. If you have diabetes, Hepatitis C, heart disease, a history of cancer, a seizure disorder, mood disorders such as depression, anxiety or bipolar, and on and on. These are issues that it is hard for the average agent to provide good service on. These are issues that will get automatically declined with most property casualty companies (auto, homeowners).
How do you know you’ve called the right person or stepped in the right door? All insurance agents make money from the culmination of a sale, the placing of a policy in force. They all want your business and the truth is that most of them are struggling. There is a real tendency in the business for agents to take on business that they have no idea what to do with, just in hopes that it works out. It usually doesn’t. You know you’ve found the right agent if they show a knowledge of your particular issue by the questions they ask. If they don’t ask questions they don’t have the information it takes for them to come through for you. If they don’t seem to know, for instance, the difference between type 1 diabetes and type 2 diabetes, they don’t have any business working for you.
Bottom line. Before you commit to applying through an agent, be confident that they know what they’re doing. In my next post I will reveal the secret weapon for weeding out the BSer’s from the straight shooters. It works every time, guaranteed.
May 28th, 2008
I know at times I pour it on pretty thick about the whole lifestyle thing, but lifestyle simply cannot be overstated when it comes to its’ impact on life insurance underwriting.
As posts go this one is short and to the point. Through diabeticconnect.com I found a review of a book
that really puts the spotlight on the impact of lifestyle on health. Again, I would like to recommend Diabetic Connect as a resource. I mentioned in a post a few days ago that I believe they will be the new best advocate on the block for those with diabetes.
Bottom line. Positive lifestyle changes increase your chances of avoiding or controlling issues like type 2 diabetes, high blood pressure, obesity or cholesterol. Avoiding or controlling those types of issues can only have one type of impact on life insurance rates….positive!
May 20th, 2008
Last week I mentioned in a post that there seemed to be something of an epidemic of adult onset type 1 diabetes, a hybrid of sorts that is starting to pick up steam under the new name type 1.5 diabetes.
Here in Colorado, outside of our small epidemic, diabetes was brought to the forefront the other day when the Broncos starting quarterback, Jay Cutler, was diagnosed with type 1 diabetes (or type 1.5) at the age of 25.
I know it happens more frequently than I’m probably aware, but there is something that just gives you one of those think twice moments when a young adult who is doing all the right things is diagnosed with a manageable, but serious illness.
Bottom line. Life insurance is available at fair rates for those with diabetes, whether type 1, 1.5 or 2 as long as it is well controlled. Check with your independent agent about it today.
May 13th, 2008
It’s been a while since I’ve brought this up, but let’s be very real about this. There is a type 2 diabetes epidemic going on in this country and it seems to be riding into town sitting squarely on the tail gate of the obesity epidemic.
So Ed, how many people does it take to screw in a light bulb? Wait. Wrong question. How many people does it take before someone believes a problem has reached epidemic proportions? Is 20 million enough? That’s how many people are estimated to have type 2 diabetes in America. Is 80-100 million enough. That is the number of BMI 30+ obese people are estimated to be tromping around the US. Since obesity is the leading culprit in adult onset type 2 diabetes, is anyone willing to say we have an epidemic sized problem on our hands?
That is the bad news. The good news is that for those who realize they have a problem and get the right treatment and control their health issues, life insurance can still be affordable. Very often people are led to believe that being overweight or having diabetes or heart disease is the end of their chance to have life insurance. It’s true that if a person is diagnosed with a serious health issue and can’t or doesn’t get it under control, it can make getting affordable life insurance hard to impossible. For those who accept the challenge and take control of their health, you can be right back in the middle of the life insurance pack at standard or better rates.
Bottom line. As a nation we need to come to grips with the epidemics. As individuals we need to come to grips with our personal lifestyles and future health. We can choose not to participate in the epidemic.
May 9th, 2008
My wife was telling me the other day about a man in our church who had been diagnosed with type 1 diabetes last week. He’s 40 something years old. I know that most type a diabetes onset is in early years, generally under 25, with the majority of it under age 15.
I also know that adult onset type 1 isn’t an unheard of thing. In fact I posted a blog not too long ago on type 1.5 LADA, essentially adult onset type 1 juvenile diabetes. It isn’t a take off on type 2. It is truly an insulin dependent late onset mutation. Anyway, we talked about the fact that we were able to find several reasonable life insurance offers on the case that brought 1.5 to my attention.
But where I was going with this has to do with the size of town I live in, about 6,000 people. Apparently last week our church friend was one of 10 people in our town that were diagnosed with adult onset type 1. I think, statistically speaking, that number is off the charts.
Bottom line. I hope to be able to interview the doctor (they were all seen by the same doctor) and get his take on how that could happen. Stay tuned.
May 8th, 2008
Previous Posts
