AVR Causing Life Insurance Denial??

[Sir Reel]

Has anyone had life insurance denied on the basis of their aortic valve replacement? I changed jobs a year ago and the life insurance company (Prudential) denied coverage in excess of the guaranteed coverage amount on the basis of my aortic valve replacement surgery. In other words, you are guaranteed an amount (2x salary) and have to medically qualify for more (say another 3x salary).

As far as I can tell, the insurance company is denying the coverage solely on the basis of the surgery. Mine was routine as far as AVR goes and I am otherwise in excellent health.

I am pressing the insurance company for a more complete understanding. I just wondered if anyone has any further information regarding how AVR surgery is viewed in the insurance community.

Thanks.

 

[geebee]

I have had MVR and have been turned down for anything other than employer guaranteed life insurance. I have applied every few years since 1980 and always get turned down. Most recently from AFLAC coverage offered by the Fire District I work for.

Although I have a few health issues besides the MVR, I am not in treatment for them and they were all diagnosed more than 5 years ago so the only thing that was applicable on my recent application was my MVR and that was almost 13 years ago.

It is hard for me to believe that I am more of a risk than the firefighters but I guess any use of the word "heart" when it comes to life insurance is taboo.

I also guess the actuarial tables know something my doctors do not (or my doctors are lying to me about expecting a normal lifespan).

 

[sue943]

I was lucky, I took out a large policy in 2002, my problems started three years later. My financial adviser told me that I need to keep the policy going as no one else is going to insure me now.

 

[tobagotwo]

Only too true, Sue.

Sometimes companies sponsor a no-letter-of-good-health-requirements boost to insurance. To anyone reading, if you have the option to up your life insurance do it.

If your children have bicuspid valves and they can get insurance when they start work, help them get and maintain a good policy that they may not be able to get by any other means later, especially if they eventually have surgery. Don't let them allow their insurance to lapse at any point.

Best wishes,

 

[Lisa in Katy]

I was denied coverage before surgery because of the Rheumatic Fever and murmur and after surgery because of the fix! Either way, heart problems are heart problems and scary to insurance companies. I was able to qualify for a high risk policy through Allstate, but very little coverage and very high cost, so I just go with the maximum that my employer offers me.

 

[LUVMyBirman]

It is my understanding that valve replacement recipients fall into the "high risk" catagory. Someone once pointed out that we are just as high of a risk (in the eyes of insurers) as a HIV patient. Not so sure your doctor would agree. Insurance compaines look at more than just statisitcs when making the rules. In short....you would be hard pressed to obtain a life ins policy after valve replacement. As Lisa pointed out....sometimes beforehand as well. Don't know what gave me the foresight....but I took out my policy 10 years before finding out I had such issues. Once you have it....they can't revolke it. Unless you do not pay your premium.

 

[WayneGM]

I was an insurance agent in another life (in Canada but the underwriting theory is the same in the U.S.) and an AVR (or any diagnosed heart problem) will result in a higher risk status in comparison to somebody who is considered "average" (i.e. no health or safety issues that deviate from the average population base since insurance risk is based on the average population as the benchmark). Depending on the company or coverage applied for we may or may not be denied coverage but at the very least we'd be "rated" as a higher risk than the "average" majority and have to pay a higher premium. While AVR may be routine procedure these days, we're still considered a minority population so in order to keep insurance premiums down for the majority, we are levied a premium, or may even be excluded from coverage, to do so. As mentioned previously, the beauty of covererage obtained prior to diagnosis is that it is typically irrevocable by the insurance company unless you stop paying the premiums. A word of advice to anyone who may be thinking of changing jobs who has group insurance benefits, or refinancing an existing loan with life/disability insurance, these actions will terminate existing benefits and you will have to reapply for new ones if offered. If you had these before diagnosis, you may now find that you may not qualify or have to pay a higher premium for identical coverage.

 

[PJmomrunner]

I haven't looked into it yet, but I saw a commercial on television for life insurance through AARP that claims you can't be turned down for any reason. You do have to be a member, and I think that means you have to be at least 50 (?). Might be worth checking out.

 

[Guest]

Has anyone had life insurance denied on the basis of their aortic valve replacement?

*nods and raises hand*

I have.

So, I always get the employer group benefit ... and, so far, have been able to keep the policy that I had through my first employer, even tho I haven't been with them for a couple years now. Yeah, it's a higher premium, but, imho, well worth it.

I admit it ... I envy those of you who've been able to get a policy before your troubles started. Sadly, for me, mine were from birth ... so no such luck .



Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
PICS:lego.HO.model.MCinfo.RT.CHD = http://www.chevyasylum.com/cort
"Something's wrong in the world today" ... Aerosmith ... 'Living On The Edge'

 

[Magic8Ball]

Yep, i had policies either denied or accepted with rediculous premiums when i was in the UK so i never bothered as i didn't think my condition was that bad at the time (good old education by the NHS).

When i moved to Auz i never bothered trying but as luck should have it i stopped contracting about two years before surgery and took a job with a company that gave me insurance for time off work and life insurance as part of the package so i'm never leaving my job no matter how bad it becomes.

I'm going to try to up the death cover in a year or so, i tried before surgery but they said i needed to have a medical and i didn't have time to do that before going under the knife. I'm expecting the right royal runaround when i try to up the cover both on a yes/no basis and a $$ basis.

I think the company i finaly got accepted on in the uk with higher premiums was pearl but if you have had surgery you may not have any better luck with them.

Regards.

 

[Mb]

When my husband and I first married, we applied for life insurance. He was 22 at the time. Unfortunately, we trusted the insurnace agent, who said to apply for the smallest amount of life insurance, and if he got that, then it wouldn't be a problem getting more. He got $5,000 worth of life insurance. He applied a year later, at 23, and was denied. Never was able to get more life insurance, as we were told he was in a "risk pool". He never had repair surgery until he was 55 years old. I am glad we knew that at a young age, so that we prepared financially in other ways. (real estate investments)

I think anyone with heart problems, young or old, will have a problem getting life insurnace, unless you don;t tell the truth on the application.


Marybeth

 

[marciemarine]

I never thought about the life insurance possibly being denied. Gulp! My husband was just going to get me life insurance through AARP I'll let you know how it goes! Marcie

 

[Kate]

I have a question about life insurance. I can understand wanting it when your children are small or if one member of a couple would be unable to the pay the bills if the other died unexpectedly. However, if one is single or in a couple where both people make a good living and could comfortably support themselves if necessary, is there any reason for life insurance? Kate

 

[marky]

I have no insurance..
I can't get it because I have Prolonged QT ..which is very high risk. A Defibrillator and Now with the MVR.. forget it!

 

[WayneGM]

Originally posted by Kate
However, if one is single or in a couple where both people make a good living and could comfortably support themselves if necessary, is there any reason for life insurance?

Every situation is different, but in Canada in such cases life insurance is typically used to provide immediate funds for funeral expenses, probate fees, unpaid taxes, etc and any other costs that may need to be dealt with by the Executor while the estate may still be unsettled. Also, it can be used to eliminate the need for the surviving beneficiary to liquidate assets to pay for such things if the timing isn't right to do so (e.g. stock or real estate investment prices are low) or to avoid possible tax consequences in the hands of the beneficiary of doing so (I am only speaking from a Canadian tax law perspective as I don't know how it works in the U.S.). However, beyond traditional life insurance, AVR will also impact the ability to purchase other products in the life insurance family, such as Critical Illness insurance which is a type of insurance issued by life insurance companies (at least in Canada) for the "living" that pays a lump sum benefit when you are diagnosed but survive a serious illness to help protect against the financial consequences of having a life-altering illness, such as loss of income (for example because you must take a pay cut as career change stems from your illness), medical costs, or home modifications). This is separate from Accident & Sickness (Disability) insurance in Canada which pays periodic replacement income benefits for only as long as you are disable and can't work. The ability to purchase A&S insurance would also be impacted by AVR.

Originally posted by rckrzy1
What about health insurance when changing jobs ? Anybody not able to get put on a group health policy ?

This would depend on the group policy the new employer has. Some policies will provide a basic level of guaranteed benefits to all employees, regardless of health, with the option to qualify medically for additional benefits. Others will exclude coverage for "pre-existing health conditions" at the time you enrole in the benefits package when hired by the new job.

 

[SumoRunner]

I have never been able to get life insurance except through group policies from work. I was considered uninsurable since the initial diagnosis at about age 10, so I never gave it much thought.

I have one from a previous job that I was able to convert when I left. But that was 1971 and it's only worth about $10K. I do have the standard group coverage where I work now which is double my annual salary but I don't think I could carry that on when I retire.

I have never had any difficulty getting the health insurance from my work or my wife's plan either.

Life insurance is a rather poor investment anyway. The annual interest is lower than you would get with any other vehicle. There was one for $500 that my mother took out on me when I was born. She forgot all about it until she found it one day in a shoebox when I was in my 40's. I cashed it in and was amazed at how small the return was. Had the money been put into anything else, including Gov't bonds the return would have been much greater.

 

[catwoman]

I have a question about life insurance. I can understand wanting it when your children are small or if one member of a couple would be unable to the pay the bills if the other died unexpectedly. However, if one is single or in a couple where both people make a good living and could comfortably support themselves if necessary, is there any reason for life insurance?

Kate:

Circumstances can change.
I've seen extreme situations, one in which a neurosurgeon was diagnosed with a terminal illness and it wiped out his savings. There was no $$ to bury him with. The county paid for his burial.

 

[Guest]

Circumstances can change.

*nods*

Exactly. My parents have instilled in me the need to maintain health insurance, life insurance, investments (401k, ira, etc.) and save save save. Sometimes, they think I worry about it TOO much ... he he eh.

But, I wouldn't go without either ... because you just never know.....

*sighs*



Cort:33swm."Mr Monte Carlo.Mr Road Trip".pig valve.pacemaker
PICS:lego.HO.model.MCinfo.RT.CHD = http://www.chevyasylum.com/cort
"Finding out the hard way what freedom means" ... Baillie and the Boys ... 'Wilder Days'

 

[Lisa in Katy]

rckrzy1

I found the following information on a website about insurance in different states. Group health insurance applies to companies with greater than 50 employees.

Group Health Insurance in Texas
Coverage may not be denied to qualified persons due to health problems. Neither may they be charged more.
New employer may withhold coverage for a period of time.
Special opportunities may be available during life changes dealing with marriage or job loss.
Small business employer are required to include family members under health coverage.
Newborn, adopted, grand, and disabled children are offered special consideration for health coverage.
Except for HMOs, group providers may review medical history for the six months immediately prior to new coverage.
Providers may require an exclusion period for up to 12 months.
HMOs may not impose exclusion periods but may require an affiliation, or waiting, period.
Creditable coverage for a pre-existing condition is available when previous coverage was maintained without a break longer than 63 days.

The first sentence is the important one. Although some of this sounds like you can be denied, that is only if the entire company has "new coverage." If they change from one plan to another, you are covered. Also, as long as you currently have insurance, when you change employers to a small group of 2-50 employees, often the HIPAA applies, and you can continue coverage. If all new employees have a waiting period, the same would apply to you, so you would need to COBRA if necessary so as not to have a break of more than 63 days.

 

[Lisa in Katy]

BTW, I have been on my husband's health plan in the past because it was less expensive (insurance companies really take advantage of us teachers - too many women and children!). He has been under 4 different plans since my surgery and no one ever asked medical questions - all large groups. He recently changed jobs and his new employer charges a much higher rate for spouses who are waiving their own employer's insurance, so I decided to go with my own employer's plan. Again, no questions asked. All I had to tell them was that I had a qualifying life changing event and I was added immediately.

Before surgery, I was denied coverage in a small group plan in 1989 (fewer than 10 employees) and had a waiting period for another small group plan in 1993, but never had a problem with large groups.