The Gulf Of Disagreement Between Physicians And Life Insurance Underwriters!

This is one of those days that makes me think about the “Men are from Mars and Women are from Venus” line of thinking. Little did they know when that was written that they would give the planet with water to men!! It could easily be changed to “Physicians are from Mars and Life Insurance Underwriters are from Venus.

To say that they look at medical issues differently is certainly accurately, and should be. But there are parts of what both sides do that bug the heck out of me, so you guessed it. I’m venting. I have a client who was seen several years ago when she was having palpitations of the heart, likely stressed induced as this is one high power lady. She saw her doctor who ordered a cardiac workup, an ekg and a stress test. Her doctor told her everything looked fine. She just needed to slow down and de-stress a little. She wasn’t put on any meds and did as she was told and hasn’t had any recurrence of the palpitations. End of subject, right?

But no. She applied for insurance recently and we were both surprised when the company looked at the medical records and said the ekg from 6 years ago was abnormal and for that reason they rated her to table 3. Nothing from the underwriter about what was abnormal or how the came up with table 3. They have the luxury of being vague when they want to. That doesn’t make the job of placing the insurance policy any easier because I am now stuck between a doctor that says she is fine and an underwriter that says her ekg is abnormal. The truth is they are probably both right. There may have been some small abnormality on the ekg (you have to assume small because he approved it) and even though the doctor probably noticed it, if it isn’t relevant to the health of the patient they aren’t going to unnecessarily worry her. Somehow, “Everything’s fine even though your ekg was abnormal” isn’t something many doctors will say.

So who am I beating up on? I’ll start with my own industry. Life insurance underwriters, most of the time dictated by the companies they work for, make completely inappropriate knee jerk underwriting decisions on issues that are not mortality riddled. In the case of this company or this underwriter an abnormal ekg made the case go from standard to table 3. Does the underwriter understand the abnormality and can he define the mortality risk caused by it? Not likely. But the book says abnormal is table 3 in his company. Is he willing to dig any deeper to see if that’s really a merited rating? No, not likely. Does he understand that as an agent I have to have more detail than “abnormal ekg” to place a case? Absolutely not. Does he care if I place the case? Nope!

Now the doctor. Personally I think it is about time doctors started treating adults like we’re grown up adults and tell us what they know instead of what is easy for us to hear. He could have shown her the slight abnormality in the ekg and told her what it meant in the whole scheme of things (nothing) and let her go as a more knowledgeable patient. Tell the truth. Everything is fine is incomplete information. You have this little blah blah on your ekg that means blah blah when your heart beats but it isn’t going to affect your health at all. You know what this doctor did. He told the client everything was just fine and then he wrote in her records that there was a slight abnormality on her ekg. I know it has to be right up there with reading a dictionary, but everyone, and I mean everyone, should take the time to read your records and find out all of the things your doctor hasn’t told you.

I’ll shop her case to a more heart friendly company and she’ll still win the day, but just a little more grown up on each side of the aisle could have made this whole thing turn out just fine the first time.

Makes me wonder what doctors and underwriters are going to do with the news today that a study now says definitively that PSA tests are not an accurate test  for prostate cancer. If health insurance quits paying for the test, doctors will stop doing the test and then what are underwriters going to do. Will they keep running a PSA? Will they bag the PSA because it is kind of an expensive test? Personally I disagree with the study. A much higher percentage of my clients have found out that they have prostate cancer because their PSA was elevated on the exam than their studies indicate. Of course mine isn’t a scientifically controlled study but I can tell you that those with prostate cancer were very grateful to know that their PSA was elevated. At least there was something abnormal that led to a further check. We’ll see how this one plays out.