So, BNP (natriuretic peptide). What the heck is it? In layman’s terms (so I can understand it), BNP is a protein release by the heart that could indicate congestive heart failure. But listen up all of you life insurance underwriters……It could mean a half a dozen other things and occur when no life threatening changes occur in the heart. I have a BNP of 222, more than twice normal and it is attributed by one of the best cardiologists in Colorado to my right ventricle being enlarged even thouugh I have normal RV systolic function. No mortality risk.

This goes along with whole idea we’ve discussed many times of clinical underwriting. Look at the whole picture before taking unfair underwriting action. Some companies used to jump to unreasonable conclusions with the liver function test GGT (Gamma-Glutamyl Transferase). The underwriter would immediately assume the client drinks too much and they would decline the application. No followup questions. No alcohol questionnaires. If your GGT was high you were a drunk. Never mind that GGT is nothing more than a measure of irritation to the liver. It can be elevated by taking Ibuprofen over an extended period. With proBNP, for the few life insurance companies that even use the test, they assume that high levels mean that the client is suffering from congestive heart failure (CHF). They decline the person and suggest they see their doctor right away. That happened yesterday with a business life insurance client, CEO of a large Midwest company.

This CEO does have permanent atrial fibrillation and very well controlled type 2 diabetes. Because he’s proactive about his health, he has stress tests that are cardiac poster child perfect, and he plays tennis 3 times a week and, well, just doesn’t act, feel or present any symptoms of CHF.  I’m not a doctor and I’m not an underwriter, but it seemed to me that declining life insurance for someone for something they weren’t suffering from could be kind of malpractice (I’m not a lawyer either) Worse yet it could give life insurance underwriters a bad name for jumping to medical conclusions that aren’t correct sending people scrambling for their doctor’s office to get checked out. Some would say those underwriters are playing doctor without a license.

So, it turns out that the original reason that this client came to me, atrial fibrillation, is in fact one of the “other causes” of high proBNP readings. In the absence of CHF or symptoms of CHF, and in the presence of atrial fib, the reading is pretty much irrelevant. So, we presented the underwriter and medical director with a letter from the CEO’s cardiologist explaining his lack of concern about the BNP and why.The underwriter accepted our request for review, went over it with their cardio medical director and put it back in underwriting.

Bottom Line. It’s refreshing when we don’t have to battle to the bloody nubs to get attention brought to a situation like this. It’s refreshing to have a class act company have class act life insurance underwriters and backup medical directors. It’s always, always refreshing when a life insurance decline turns into an approval.  If you have questions or need quotes, please call or email me directly. My name is Ed Hinerman. Let’s talk.