Getting the procedure right when doing medical tests or a full medical examination is vitally important to avoid having future insurance claims jeopardised. Adviser Brian Klee provides a practical guide on what to do.
Thursday, April 12th 2001, 3:22PM
by Brian Klee
Preparing for a blood-screening or urine test - view
When you or your client is required to have a blood-screening test, urine test, or full medical examination, there are various things you can do to prepare them. This is to minimise the risk of adverse findings that could jeopardise an insurance application.
There are two kinds of exam findings leading to abnormal test results:
Those due to an underlying medical condition or illness; and
Those provoked by transient, unimportant, non-illness related causes. This latter finding is sometimes called "false positive" findings. It is this area we will particularly address.
Blood-Screening or Urine Tests
In preparing your client for blood/urine tests, attention must be focused on 4 factors:
1.
If your client's blood tests are fasting, then no intake of food or beverages, other than water, for 12 hours prior to the tests. If your client's blood tests are not fasting, then no intake of food or beverages, other than water, for 120 minutes prior to the tests - this also applies to urine samples. This allows time for glucose to be metabolised following food ingestion.
2.
Avoid strenuous exercise for at least 12 hours prior to the blood/urine tests, and medical exams for the following reasons:
Liver enzymes (AST), part of every full blood profile, are susceptible to temporary elevation from muscle trauma due to vigorous exercise.
Both protein (albumin) and blood (red blood cells, hematuria) have been known to show up in urine as a result of recent exercise.
Stationary bicycling can raise a male's prostate specific antigen (PSA) level as much as 3 times - leading to more tests or even outright Decline.
3.
Insurance blood/urine tests should ideally be avoided after a recent trauma or physical injury, during a fever or an acute illness, or in the first few days after hospitalisation.
4.
Make sure that you question your client thoroughly about any use of prescription, over-the-counter medicines and related remedies. This includes herbs, hormones, dietary supplements taken for whatever reason and so on. The only way an underwriter makes the connection between abnormal blood or urine test results and the fact that your client uses a medication capable of causing that abnormality is, if the underwriter knows your client it taking that medication!
Blood pressure and pulse reading issues
Suggestions and recommendations that can influence blood pressure and pulse readings.
Even the most meticulous preparations cannot completely eliminate "false positives". If we understand how certain factors may adversely increase the risk, then we can intervene to minimise it, e.g. both blood pressure and pulse readings can be raised by widely consumed stimulants such as caffeine (including tea and cola) and nicotine.
The following factors have also shown to adversely affect blood pressure reading:
1.
Make sure your client empties his bladder before his blood pressure is taken.
2.
If your client has a large arm, ask him to remind the GP/nurse to use a wide-arm cuff when taking his blood pressure.
3.
The phenomenon known as "white coat hypertension". This loosely translated means any medical authority dressed in working clothes (hence "white coat") often makes people tense. The solution to this is to use Healthscreen nurses where possible.
4.
Acute caffeine intake can hike systolic blood pressure (highest number) by as much as 10 units. The diastolic reading (lowest number) can go up by 8 units or more.
5.
Cigarette smoking can similarly increase blood pressure. The effects of smoking does not last quite as long as those induced by caffeine, yet, it can potentially raise both systolic and diastolic blood pressure for an interval of time.
6.
Stress and alcohol intake can also influence blood pressure and pulse readings. So, in saying this, precautions need to be taken in preparation:
The client should have a good night's sleep beforehand
Caffeinated beverages should be avoided for two hours prior to the exam OR if they are to have fasting bloods, then no beverages or food for 12 hours prior
Tobacco should never be used within two hours of tests or medical exam
A report from the University of Toronto Medical School reviewed all the factors thought to affect the accuracy of blood pressure readings:
a)
Chronic caffeine ingestion - even though caffeine must be avoided within two hours of the exam, regular use of caffeinated beverages does not produce chronically elevated blood pressure.
b)
Decongestant nasal spray - thousands of New Zealanders use nasal decongestants that contain adrenalin-like chemicals. It seems logical to assume that recent use of sprays could raise one's blood pressure - not true.
Choosing and Working with Medical Examiners
Healthscreening is a mobile service, i.e. at your client's work or home. This service tends to be more convenient, while fixed-site examination centres offer the advantage of having special testing facilities when difficult issues are impossible to do 'on the road'.
There's only one essential rule to be adhered to when selecting a medical examiner: if your client has a history of a heart condition, make sure the examiner is a Cardiologist. Avoid having your client sent back for a second opinion simply because the original exam was done by a less qualified doctor!
Another standard worth considering is the availability of testing facilities, e.g. treadmill stress tests, ECG's and chest x-rays. If the medical examiner cannot perform those tests without delay in their office, do not inconvenience your client and select an examiner who can.
Medical Exams, GP Reports and You
It's important to recognise how you, the Adviser, and such medical reports interact:
Because we sometimes see multiple physicians, there are sometimes 3, 4 or even 5 medical reports required to assess an application. The GP (#1) sends the client to a specialist (#2), who hospitalises them for an investigation (#3), then calls in a specialist to consult (#4) and a surgeon to perform a biopsy (#5). All of those reports might involve just one impairment - what say there are two!
Sometimes the report from the GP contains details and copies of correspondence from specialists, hospital discharge summaries, lab reports, etc. These may allow the underwriter to waive other requests. The case remains pending until all reports are received and reviewed.
Shorter is not better! Very terse medical reports often raise as many questions as answers. They may force underwriters to write back for amplification, or to order additional tests. This means the case is further delayed and might be jeopardised even further. Contrary to popular belief, you and your client are not well served when physicians greatly abbreviate, or overly edit, these reports.
Depending upon the nature of the history, certain pieces of information might be vital. The classic example is the cancer pathology report. You cannot underwrite a cancer risk without knowing precisely which kind of cancer the client had - and there are 100's. You cannot ascertain the risk in anyone with a history of cancer until you examine, in detail, the specifics of the pathology report as to extent of disease, prognostic factors, etc.
Another example of vital underwriting documents is the full report from a cardiac catheterisation that will contain all-important measurements that distinguish healthy hearts, from transplant candidates.
If you are involved in expediting such medical reports, be alert to the need for these essential documents. Remember, if it is cancer case and the report is sent in without the pathology report, the case file goes back into orbit around the underwriter's desk while a second request gets sent to the doctor. These sorts of delays usually mean more conservative underwriting outcomes; for cancer survivors who often approach insurance cover apprehensively anyway.
Note: If a doctor balks at complying with the client's authorisation to send a report, the client should remind them that those records are the property of the patient; not the doctor! The client, as the patient, is not asking the GP, or specialist, to send a report of his records, he is telling them to do so. We are usually not so blunt, but that's the reality of the situation.
When such reports are inaccessible, the underwriter can ask these questions:
Is there an alternative source for this information?
Might current testing provide enough information in order to take action in lieu of the report(s)? The key question is: "What is the medical history?" A heart murmur might be reconciled with a cardiologist's examination or an echocardiogram. However, a complex neurological history cannot be underwritten without the historical reports.
Can action be taken without these reports? An expanded statement from the client, with as many details as he can remember, will be essential if this option is to be seriously considered. Action may then be taken with the clear understanding that it is for "this amount of coverage only" and that additional insurance will require further underwriting.
We hope you have gain value from these series of articles and if there is something specific you would like help with, we look forward to hearing from you.
This article was provided by Brian Klee, managing director of Special Risk Insurance Services (www.srisks.co.nz)
