Trends in Insurance Lab Testing

Transcription

1 Trends in Insurance Lab Testing Moderated By: Gerri Bishop

2 CDT Lisa Goldsmith Protective

3 Case Study For CDT Female age 70, trial for $2,100,000 Aps: 12/08 SGOT 161, SGPT 200 1/09 SGOT 100, SGPT 124 4/09 office visit notes that she drinks 2 glasses of wine per day. Told to reduce alcohol liver enzymes in aps back to normal but HDL 97, AST/ALT >1, and MCV 96 Insurance labs: AST 36, ALT 29, GGT 13, HDL 97 Positive CDT

4 Case Study For CDT - continued Case quoted Table 2 due to history of elevated liver enzymes, daily alcohol use, elevated HDL/MCV and positive CDT.

5 Case Study For CDT - continued Received appeal and additional lab ticket 2 nd blood profile taken on same day only 15 minutes apart from 1 st sample. Sent to heritage labs (positive CDT came from clinical reference labs). Blood profile sent to heritage: CDT negative Please note that heritage, in addition to providing positive/negative findings, also has the actual numerical range they use in determining cut offs for these findings. In this example, the CDT came back at 2.2 (0-2.2%), which is borderline high but still falls within the range that the lab would consider negative.

6 Case Study For CDT - continued Additional factors to consider: Clinic notes from 4/09 office visit at time applicant was told to cut down on alcohol was in context of looking for ways to prevent her osteoporosis rather than a concern with alcohol abuse. Applicant was on Oxaprozin for arthritis at that time. (One of the side affects of this medication is elevated liver enzymes) Once applicant had shoulder surgery and was no longer on Oxaprozin, her AST, ALT and GGT returned to normal. Information in medical records indicate that applicant runs and is athletic (not consistent with alcohol concerns but along with age/gender may account for elevated HDL) Alcohol questionnaire and inspection report both indicate current alcohol use = 1 glass per day MVR clear

7 Case Study For CDT - continued Decision: Clinical notes not consistent with history of alcohol abuse, clear mvr, no concerns on inspection report or alcohol questionnaire and 2nd blood profile within normal limits. Case approved PREFERRED (Would have been willing to consider for Select Preferred except for history of hypertension.)

8 Low Cholesterol Doug Capstraw AXA

9 Low Cholesterol 1. Low cholesterol may indicate: Hyperthyroidism, or an overactive thyroid gland (in severe cases, potential mortality concerns are arrhythmias including atrial fibrillation, weight loss, and osteoporosis) Liver disease Malabsorption (which can cause weight loss, anemia and bleeding tendencies) Manganese deficiency (many nutrionists attribute many diseases including Parkinson s Disease, Osteoporosis, Schizophrenia, Diabetes, and Epilepsy to manganese deficiency.)

10 Low Cholesterol - continued 2. Low cholesterol may be linked to: Anxiety and depression Suicidal behavior Hemorrhagic strokes (one study found that men with cholesterol levels below 150 mg/dl had four times the risk of cerebral hemorrhage compared with men with cholesterol levels above 190 mg/dl.) 3. Low cholesterol may reflect an undiagnosed cancer Two studies, reported in the journal cancer epidemiology, biomarkers & prevention, affirms that lower total cholesterol may be caused by undiagnosed cancer.

11 Low Cholesterol Case Study #1 Age 60 Applying for $5 million of UL 5 9, 188 lbs., Stable weight On lipid medication All medical history is favorable Cholesterol 110, HDL 35, Ratio 3.14

12 Low Cholesterol Case Study #1 - continued Decision: With favorable medical history, and being on a lipid medication, we would attribute the low cholesterol to the lipid medication and allow best class.

13 Low Cholesterol Case Study #2 Age 52 Applying for $7.5 million of UL HX of hypertension, BPH lbs., Stable weight Not an any lipid medication All other medical history is favorable Cholesterol 118, HDL 33, Ratio 3.57, ALT 47 (45)

14 Low Cholesterol Case Study #2 - continued Decision: With cholesterol < 120, over age of 40, guidelines indicate to review with MD, usually decline. On this case, as all other medical history was favorable weight stable, all labs normal except for the mildly elevated ALT, we held to standard, but could have postponed until the reason for the low cholesterol was determined.

15 BNP Michelle Palmer Principal

16 BNP Case Study #1 Male age 77 Hx chronic a-fib on Coumadin Echo w/la 4.8, o/w wnl BNP 500

17 BNP Case Study #1 - continued Decision: A-fib is +100, reduced to +50 since client is being anticoagulated = T-2 this aspect, no add'l for LA and since the client has no signs of CAD, the BNP at his age is acceptable and no add'l debits that aspect either. (If the client was much younger we would likely decline or be very high substandard).

18 BNP Case Study #2 Male age 60 C/O SOB Long hx anxiety on Xanax OA in knees BNP 75

19 BNP Case Study #2 continued Decision: Evaluation for SOB included PFT (FEV1 88%); could not do stress test d/t knees, but persantine thallium test was done and normal, no perfusion defects This minimizes the chance that SOB d/t cardiac hx, therefore BNP of 75 (wnl) also helps determine that the SOB is not likely due to diastolic dysfunction and a favorable determination could be made that the SOB is secondary to the client's anxiety.

20 A1c Jeff Brunsen Aviva

21 A1c Case Study

22 A1c Case Study - continued Aviva Assessment #1 Preferred Non-Tobacco rate class* *Aviva has established preferred diabetes guidelines beginning at age 70 #2 Standard Non-Tobacco rate class* *Aviva has a Table Reduction program with maximum limits to age 70, 10,000,000 face amount, permanent products, and Table 3 or better rate class.

23 KFT Tim Kitzman ING

24 KFT Case Study Male, nonsmoker, age 75 History of mild non-ratable coronary artery disease Insurance lab normal except for current serum Creatinine level of 1.59 ( ) egfr calculation = 47.5 (renal insufficiency) This degree of renal insufficiency on it s own is at least moderately ratable a this age. MODIFYING FACTORS: Review of medical records show creatinine levels over time, going back to at least 2005 have been in the range of 1.4 to 1.5. Current BUN is normal at 17 Slight hemolysis noted on lab report Current HOS is negative for significant proteinuria and has favorable protein/creatinine ratio of 53.76

25 KFT Case Study - continued Decision: Allowing credits for stability, potential impact of hemolysis, normal BUN, and favorable protein/creatinine ratio, ING able to take case at standard.