I have a referral that is 50, NS, 6ft 2, 175, no meds, but 12 years ago a family doc told him he had a slight heart murmor. Doc didn't treat him and has not had any problems or findings of a murmor since. Never had a cardiac work up. Would you apply first with Assurant, since in my state they only ask questions concerning conditions the past 5 years besides cancer. I fear other carriers will want him to have a cardiac workup, what are your opinions?
I don't think his heart murmur will be a problem with most carriers since its functional.
I know with Humana he would be standard. The other carriers may be a slight rate up or standard also. Best thing to do is call the underwriting department and ask.
In WI every other company most likely will pull records. Does he have coverage now or if not, has he had a physical in the last two years? I know Humana supposedly stopped requiring that, but they will pull records along with most other carriers. Golden Rule probably won't rider him, but will most likely rate standard. Anthem/BCBS will rate standard. If Assurant is even close or lower premium, save your customer and you a lot of grief and go Assurant.
I have a referral that is 50, NS, 6ft 2, 175, no meds, but 12 years ago a family doc told him he had a slight heart murmor. Doc didn't treat him and has not had any problems or findings of a murmor since. Never had a cardiac work up. Would you apply first with Assurant, since in my state they only ask questions concerning conditions the past 5 years besides cancer. I fear other carriers will want him to have a cardiac workup, what are your opinions?
1st of all, if the condition is present is needs to go on the app - even if it hasn't been treated in the past five years.
Take an example of mild scoliosis - present at birth - never really an issue - no treatement in say 20 years. Yet if it's present it's on the app.
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2nd of all, with the information given why would you have to list it on the application?
Dr said he had a "slight" heart murmor and proceeded to not order a cardiac workup or treatment. If 12 years have passed without evidence of a heart murmor or any treatment I wouldn't put it on my application.
There are health companies that ask the question in this context: "have you ever" in those cases I totally agree with you.
You would be totally in the right to not put it on the application imo.
As usual, it will vary depending on your state . . .
I have quite a few clients with murmur's. Some cardiologists estimate as many as 80% of the population will have a murmur.
Most are benign, Grade 1, and require no treatment. If your client is instructed to take antibiotics before dental work then it is something that should be noted.
You said "Doc didn't treat him and has not had any problems or findings of a murmor since"
Most apps ask if a condition has been diagnosed or treated in the last 5/10 yrs.
In this case it is neither.
If it makes you feel better, disclose it on the app.
I have never had a carrier order medical records on a murmur, except when treated prophylacticly using something like Atenolol. In both cases it became an issue and resulted in a decline.
Based on what you have posted,
Aetna would probably be standard.
GR would be standard or possibly preferred.
Humana would be standard.
Can't speak for Blue or other carriers (such as Time since Time does not address it in their underwriting guide).
I highly suggest you call a few underwriters tomorrow and ask the differrence between a client filling out an app without an agent and an agent's field UW responsiblies when they possess pre-ex knowledge. The answers here are astounding and disheartening.
Talked with some folks today. GR stated that they would want a current cardiac workup. Blue Cross said the same. Not an UW, but my contact with Assurant suggested letting the client complete the on line app and answer the questions exactly as asked. My current thoughts are to have the client apply with Assurant, hopefully get issued, then apply with BC because that is the company he wants to be with. However, the way BC does pre ex, I wouldn't be comfortable being with them. Having a murmor and then if he had a MI or stroke in the first year, is it likely they would deny the claim? In addition, the client wants to apply for a million dollar term policy, I suggested we hold up until the health insurance is completed because for sure the murmor will be on MIB.
While we are on UW outcomes. I got a feeling taking a narcotic is probably a straight decline, probably across the board. But, does anyone know any company that will issue a policy to a person taking a narcotic (vicodin) for as needed use. I know Assurant would decline, World would decline. Not sure about Humana, GR or Aetna. Thanks.
PS Vicodin prescribed for pain from back surgery with hardware 7 yo. I know this is a rider.
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Diagnosis from family doc with no formal work up = postponment. The underwriters will want to know what testing was used to determine the "slight" heart murmur diagnoses.
And here's UW 101; anytime you say the word "heart" they are going to make sure it's properly underwritten. Expect an APS at best.
This, of course, changes if it was a solid diagnoses with the proper testing. Then it should sail through.
Last edited by healthagent : 06-04-2008 at 10:05 PM.
Pain mgmt (as in Vicodin) is almost impossible to get underwritten. I have a few with KP but they are the exception more than the rule.
Your association guru will probably find reason to argue that point.
When he offers discounts on gasoline I might join.
As for the murmur, unless you spoke to an underwriter your answer is worthless. The marketing reps for carriers usually don't have a clue. When I have a question such as yours, I take it direct to underwriters. They are the ones who make the decisions on these cases, not the sales dogs.
Bob - Your post was just disussing a heart murmur in general. I read the entire post and had to correct you that this would be a postponed - never preferred or stardard with GR or anyone else.
No harm no foul - you would have been correct if a formal diagnoses would have been determined after proper testing.
Join up Bob - I'm holding a UW class on Friday - you might pick up something.
My .02 on the murmur. After reading your description again, I would say, If the doctor has run EKG's and listened to his heartbeat as part of a routine physical (and is coded that way) and has found no signs of the murmur in the last ten years, then it doesn't exist and the customer passes on the "signs, symptoms, treatment, testing or consultations" in the last ten years test. In this case, the agent has no obligation to disclose it since it also passes the pre-ex test.
If the doctor told his patient " as part of this physical I'm going to run an EKG to see if you still have that murmur or if it came back", then it is a consultation, and must be disclosed. This is doubly true if the test was coded as diagnostic. If the guy has taken antibiotics B4 dental in the last ten years, then it must be disclosed in the Rx in the last ten years section. Unless the company has an "ever" clause, it sounds like everyone is in the clear. As an agent, I'm not obligated to disclose it anymore than I would be for a broken arm when the guy was 3 yrs old, unless the condition is on a list supplied in the agent guide as a "lifetime disclosure".
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