Life insurance woes and doctor's "diagnosis"

[jeromedawg]

Hey guys,

So I recently applied for life insurance and ended up getting pushed into a super high premium range because my doctor apparently diagnosed me with "polycythemia" according to medical records.

Now, I did have lab work done earlier this year and he raised the issue indicating concern over high RBC count but seemed to play it off like it might have been a glitch just that day or something. I don't ever recall him officially diagnosing me with polycythemia. I followed up with him over emails (and left messages with his staff and asked for callbacks, but never got one), and even had a re-test done per his instructions, but he never mentioned that he diagnosed me with the condition.

That said, I am waiting for his return call to clarify some things: 1) did he or did he not diagnose me with polycythemia 2) if he did diagnose me, then why didn't he disclose it to me, and 3) if he did *not* diagnose me, how is it that the underwriters are saying otherwise (did he send them the wrong medical records or did he mix me up with another one of his patients?)

This is stressing me out big time... both because of the life insurance hold-up but also because of whatever health implications there are if he did diagnose me. He did mention that I can go give blood a couple times a year. Otherwise, if he mixed me up with another patient, this is even *more* concerning and I think it means I should get a new doctor.

Other than that, my agent is trying to get me to apply with other insurance carriers who she thinks will not dig into that condition and thinks I have a better chance going through another company.

Has anyone dealt with an issue similar to mine? And if so, do you have any tips or advice?

[jeromedawg]

So I just got a copy of the APS and I can see why the underwriter upped the premium. The word "polycythemia" is pretty clear to distinguished the doctor's notes but every other word around it isn't. This is under the "history of present illness" notes section too, so that would be very easy to conclude especially if you can't read the other writing that perhaps may put "polycythemia" in context (e.g. "need to check for polycythemia in next lab" where everything except "polycythemia is illegible). Of course, the underwriter could have asked for further clarification but it seems like they were acting in favor of the insurance company and assuming the worse.

I still need to clarify with my doctor what his notes actually say - I can't believe his handwriting is so awful. At least type it in somewhere if you can't write.

Another thing I noticed between my last two labs is that the "reference interval" (on one lab report) and "standard range" (on the other lab report) changed within a matter of three months - the first range benchmark I was over on my numbers. But the second range benchmark I was within normal-high range. The only number that changed too was RBC (hemoglobin and hematocrit stayed the same). Why would the reference interval/standard range change like that? This was between May 2016 and August 2016

[KMMK]

Yeah, it really sucks doing medical underwriting with poor doctor writing (legibility) or confusing or minimal information provided. You either have to call the doctors constantly or just give up and go with whatever is legible, as your insurance company did.

I hope you get it sorted out. This stuff is so annoying. Once I found out I was anemic on a pre-surgical screening ONE YEAR after the surgery.

[Metric Mouse]

I'd be more interested in why my insurance company wanted me off their rolls so badly...

[jeromedawg]

I'd be more interested in why my insurance company wanted me off their rolls so badly...

I'm actually using an agent and applying for term-life. She has gathered a bunch of different carriers to compare against and we chose the one that looked best and that she recommended. This all came up during the underwriting process. It's my first time buying term-life so I don't have existing insurance or anything.

[Metric Mouse]

I'd be more interested in why my insurance company wanted me off their rolls so badly...

I'm actually using an agent and applying for term-life. She has gathered a bunch of different carriers to compare against and we chose the one that looked best and that she recommended. This all came up during the underwriting process. It's my first time buying term-life so I don't have existing insurance or anything.

Ahh. That makes more sense. Thank you for explaining. Sounds like you have a helpful agent.

[jeromedawg]

I'd be more interested in why my insurance company wanted me off their rolls so badly...

I'm actually using an agent and applying for term-life. She has gathered a bunch of different carriers to compare against and we chose the one that looked best and that she recommended. This all came up during the underwriting process. It's my first time buying term-life so I don't have existing insurance or anything.

Ahh. That makes more sense. Thank you for explaining. Sounds like you have a helpful agent.

Yep, she's really good. Glad we went with her because I'd have no idea what to do otherwise. So either my doctor "forgot" about waiting to diagnose me *after* the re-test (which was the purpose of my visit) and he jumped the gun and said I had it (also not clearly disclosing this to me); or his notes actually indicate that he needed to check for polycythemia upon receiving the lab re-test results (for which I had blood drawn right after meeting with him) - but if this were the case, it's not clear because his handwriting is so awful. Don't you think it's a little irresponsible that the underwriter didn't contact the doctor or noted that they needed more clarification from the doctor because everything besides "polycythemia" was indiscernible? I can't assume that they couldn't read his writing, but so far the three people that have looked at it (myself, my wife and my agent) can't read his writing. Thinking about it, it slightly wreaks of dishonesty on the insurance company's side.

[bigchrisb]

Thought I'd chip in with my experience here (albeit in a different country).  I put in a claim on trauma insurance for a condition I have been diagnosed with.  Thus far, its taken the insurer over 6 months of processing and digging through old medical records, with a lot of nitpicking.  The claim still hasn't been resolved - they are still looking for reasons in my medical history that they could use to deny the claim.  I don't believe any exist, but they sure are thorough, and far more so than at the application time.

From my experience, if there were any possible doubt, I'd rather have it declared at the start and a higher premium.  At least that way you know it will pay out if needed, rather than having a cheaper premium and doubts over if it will pay.

[Beriberi]

Polycythemia means "too many red blood cells".  If you had a test that showed too many red blood cells, then you have "polycythemia".  For your doctor to order a repeat test, he needs a reason.  The reason? Follow up of polycythemia.  If you had not enough red blood cells, it would be "anemia".  You might have a repeat blood test to follow up on your "anemia."  If it is now normal, you are no longer "anemic" but you do have a history of "anemia".  Anemia (like polycythemia) can be related to bunches of different things, some serious, some inconsequential -  hydration status, tobacco use, chronic illness, kidney disease, cancer, diet.   Your doctor has (hopefully) looked at all the lab values as well as your exam and reported history and determined if further evaluation is needed, if the reason for your polycythemia is serious or inconsequential.

Also, I bet the underwriter can read the doctor's note - if you know what to anticipate, medical notes are fairly decodable. However, that likely requires education and experience in reading doctors' notes.   

[spicykissa]

The reference values can vary somewhat from facility to facility, depending on which lab instruments are used and how they are calibrated. (I'm a nurse, not a lab tech, so that's the extent of my knowledge.) Normal reference values can also differ by gender, age, and race. Were your labs drawn at the same place both times? Variations like that are why labs need to be interpreted by a healthcare professional, in the context of your individual medical history.

 

[JoJo]

Are you applying for a large amount of insurance or age 65+?  It's not common to order APS unless you have unusual reading in blood test or you meet one of those other criteria.

[jeromedawg]

The reference values can vary somewhat from facility to facility, depending on which lab instruments are used and how they are calibrated. (I'm a nurse, not a lab tech, so that's the extent of my knowledge.) Normal reference values can also differ by gender, age, and race. Were your labs drawn at the same place both times? Variations like that are why labs need to be interpreted by a healthcare professional, in the context of your individual medical history. 

You're right - the tests I think may have been done at different facilities. The lab reports look different too. Thing is, they always draw my blood at my doctor's office, so it's possible they used different labs to analyze the results each time? 

Are you applying for a large amount of insurance or age 65+?  It's not common to order APS unless you have unusual reading in blood test or you meet one of those other criteria.

In short, yes, it's a pretty significant amount of insurance.

Polycythemia means "too many red blood cells".  If you had a test that showed too many red blood cells, then you have "polycythemia".  For your doctor to order a repeat test, he needs a reason.  The reason? Follow up of polycythemia.  If you had not enough red blood cells, it would be "anemia".  You might have a repeat blood test to follow up on your "anemia."  If it is now normal, you are no longer "anemic" but you do have a history of "anemia".  Anemia (like polycythemia) can be related to bunches of different things, some serious, some inconsequential -  hydration status, tobacco use, chronic illness, kidney disease, cancer, diet.   Your doctor has (hopefully) looked at all the lab values as well as your exam and reported history and determined if further evaluation is needed, if the reason for your polycythemia is serious or inconsequential.

Also, I bet the underwriter can read the doctor's note - if you know what to anticipate, medical notes are fairly decodable. However, that likely requires education and experience in reading doctors' notes.

Thanks! It might be true they were able to decipher it. Turns out though, after clarifying with my doc, that "polycythemia" was a "working diagnosis" rather than the "actual diagnosis" - not quite sure what that fully means, but how he explained it was that I have not been officially diagnosed with polycythemia and that he may have wrote it down as a means to revisit after my re-check. Either way, he said he's willing to retract/correct that note and clarify that was not his final diagnosis, especially because my re-check came back with me being within normal (but on the high-side) range for RBC.

[jeromedawg]

So my agent has been following up and working with the general agent to find the best rates elsewhere while figuring out what to do with the current application and whether or not the underwriter will consider reclassifying based on an updated doctor's note/clarification that "polycythemia" is not my actual diagnosis. She told me the underwriter will take a clarifying note/letter into consideration but makes no promises or guarantees that the rates will increase. So to have something in the 'back pocket' she has been reaching out to other companies who will accept me at the 'preferred' rate but just at a lower amount of coverage, which I think will be fine ultimately. This whole process has been extremely irritating... makes me regret not having done this much earlier when I wasn't dealing with these issues. I can't blame it on my doctor either, since he was just being detailed with his notes at the time. I hate these life insurance companies.

[Cycling Stache]

I hate these life insurance companies.

In all fairness, their job is to assess (and price) risk correctly.  If there's a risk that might affect the expected payout, they need to know about it and price it in, and I'm not surprised that they would err on the side of caution if they're uncertain given the potentially large payout.

I would be more concerned that their concern is that you might die earlier than normal.  That's what I would want to get sorted out!

[jeromedawg]

I hate these life insurance companies.

In all fairness, their job is to assess (and price) risk correctly.  If there's a risk that might affect the expected payout, they need to know about it and price it in, and I'm not surprised that they would err on the side of caution if they're uncertain given the potentially large payout.

I would be more concerned that their concern is that you might die earlier than normal.  That's what I would want to get sorted out!

Yea, that makes sense. I'm just projecting my frustrations lol :)

In the meantime, I'm trying to figure out alternatives. I have open enrollment through work so am wondering if I should get life insurance through work. Though, I think they mentioned a medical exam/lab would need to be done for that. And I have no idea how this will work amidst having already applied so recently....

[spicykissa]

I'm surprised you would have to get a medical exam for work life insurance--I know I didn't. It was pretty much automatic (in fact, I don't think I was able to decline it). But it only covers one year's worth of salary. I guess if you are looking for a large amount of coverage it might be different.

[jeromedawg]

I'm surprised you would have to get a medical exam for work life insurance--I know I didn't. It was pretty much automatic (in fact, I don't think I was able to decline it). But it only covers one year's worth of salary. I guess if you are looking for a large amount of coverage it might be different.

I thought I read or heard somewhere that if I were to sign up at the very beginning I'd be good but if I decided to opt out at the time and then opt in for life insurance later down the road, I would be subject to it. Who knows... I guess I'll find out during open enrollment!

[jeromedawg]

I'm surprised you would have to get a medical exam for work life insurance--I know I didn't. It was pretty much automatic (in fact, I don't think I was able to decline it). But it only covers one year's worth of salary. I guess if you are looking for a large amount of coverage it might be different.

I'm actually wondering if they actually stated that the premiums would be higher if I waited, etc. I dunno... I'm probably going to go ahead and get it at this point. The insurance carrier who I initially applied for is unwilling to retract their position even with a doctor's letter, because my RBC counts were on the "high-side" going as far back as 2012. Now, I don't know if they would have even cared about this had my doctor not written "polycythemia" but it's too late at this point and whether or not that triggered things or if they would have come to that conclusion themselves is besides the point. I pretty much have to move on to whatever other company will grant me favorable rates. We'll see...

[JoJo]

Anti-selection at it's best.  And we complain when insurance premiums are high.

[jeromedawg]

Hey all,

So for the optional term life through work, because I opted out last year (in favor of seeking out term life on my own), I passed up the opportunity to waive the statement of health evaluation process... had I opted in, I wouldn't have had to fill out an SOH but now I do, since I'm wanting to opt in now. Unfortunate position to be in but it is what it is... hindsight is 20/20: I *should* have opted in before getting term life outside of work and then opted out, etc after having my own term life policy, etc... This is one of those "life lessons" that I'm going to have to deal with the repercussions of (assuming no other carrier grants *anything* with all my 'baggage')

That said, the SOH for group life is asking a couple of questions:

"Are you now on a diet prescribed by a physician or other health care provider?"

and

"Have you had any application for life, accidental death and dismemberment or disability insurance declined, postponed, withdrawn, rated, modified or issued other than as applied for?"


For the first question, per high cholesterol and borderline high blood pressure my doctor has written in his notes "exercise and diet" as well as probably "low sodium foods" at some point in time - other than in his notes, the recommendations are always verbal but I don't ever recall receiving a written "prescription" and no drugs were ever prescribed (nor have I take them) related to cholesterol/blood pressure. As far as when I was diagnosed with  high cholesterol, I can't recall back to a specific date. Should I answer this question "yes" with all this information and include a 'best guess' date?

For the second question, in light of the current situation with applying for term life through another provider and getting a higher rate than what was desired (I'm actually not sure if I applied at a certain rate level and was rated higher OR if my agent just applied with no rate level preference so as to not 'lock' me into anything). Either way, I'm not quote clear on how this question (or the answer) might be impacted by my recent application - any ideas or thoughts?

[jeromedawg]

Anti-selection at it's best.  And we complain when insurance premiums are high.

I've always known my cholesterol and borderline BP were of concern but I've managed them per my doctor's orders for the most part. And in talking to several life insurance agents, these two items I knew would affect my rates which I accepted. In fact, my agent gave me estimates/quotes of the rates I should expect to get with these conditions, and I was fine with them. The big issue here was the condition of polycythemia that the underwriters pointed out. My doctor wrote it in his notes as a 'working diagnosis' (not actual diagnosis) with minor concern and possible 'glitch.' This resulted in him having me re-test, for which the lab result came back in normal range, so I didn't think anything of it. But, according to the underwriter, since 2012 my RBC has been on the high-end which is enough for them to write-in that I have a condition of polycythemia. Would this have been the case had my doctor not written the word "polycythemia" in his notes? Possibly... it's hard to tell. Either way, I was never warned by him about this possible condition and that I was in grave danger prior to all of this coming up - he told me himself that he does not think it's a big deal or symptom of anything. In fact, he still doesn't seem to think this is a major issue and just thinks I should donate blood once or twice a year. The underwriters obviously see it differently though, and yes it makes sense in terms of "risk". I think this is where the complications between the doctor's diagnosis and the underwriters interpretation often come into play. The doctors aren't going to write their notes in the context of thinking about how the patient is probably going to apply for life insurance (this obviously isn't their first concern, over the patient's actual health). So he was just being honest with what he was writing out - in this case he wrote "polycythemia" as a possible condition to look out for pending lab results - to an underwriter this could just look like he diagnosed me with it. But to him, it may have just been a 'reminder' or other reference solely for himself. In either case, due to this whole thing coming up, the rates I was expecting (which were higher than normal already and that I had expected to pay a 'premium' on) increased 3-fold...