The Mask: Life Insurance and Sleep Apnea -- Treatment Lowers Your Rates

Bothering a spouse with loud snoring or being tired during the day aren't the only consequences of sleep apnea.

Two recent studies mark the first time that sleep apnea has been linked to higher cancer risk and increased mortality rates. Sleep apnea is a chronic disorder where breathing repeatedly stops and starts during sleep. It leads to snoring, fatigue and interruptions to oxygen flow.

During episodes of sleep apnea, oxygen levels in the blood drop. Episodes can be caused by obstruction of the upper airway (obstructive sleep apnea) or by a failure of the brain to initiate breathing (central sleep apnea). Symptoms often include excessive daytime sleepiness and loud snoring. More than 50% of people who have sleep apnea are overweight. (See: Living large: health costs for obesity exceed those of smoking.")

The condition is serious, and if not treated, can lead to hypertension, lung damage, heart problems, lack of concentration and a high risk of car accidents. When combined with other disorders like cardiac diseases, mortality increases. A recent CDC study shows a link between obstructive sleep apnea and depression.

Now two studies, which were just presented at the American Thoracic Society International Conference in San Francisco, are tying sleep apnea to cancer outcomes. One study by researchers in Spain found that people with severe sleep apnea had a "65% greater risk of developing cancer of any kind," according to The New York Times.

In the second sleep apnea study, researchers at the University of Wisconsin School of Medicine and Public Health found that "people with severe sleep-disordered breathing died of cancer at a rate 4.8 times higher than people with no sleep breathing problems."

In addition to the health implications, sleep apnea is also a factor when it comes to life and health insurance.

Sleep apnea and life insurance

"A diagnosis of sleep apnea can result in a 'decline to cover' by a life insurance company. If the insurance company does provide coverage, it will be [at] a much higher rate and [with] a limitation in the amount of coverage available," says Edward Grandi, executive director of the American Sleep Apnea Association, a nonprofit advocacy organization.

Some insurance brokers, however, say that you can get equitable coverage, depending on your particular medical condition and how you treat it.

Much depends on the severity of the sleep apnea -- mild, moderate or severe -- and compliance with treatment, says Ed Hinerman of the Hinerman Group, which specializes in impaired risk life insurance underwriting.

One effective treatment is the use of continuous positive airway pressure (CPAP), which uses a mask and air pump to provide airflow during breath inhalation to prevent collapse of the airway.

People who have a mild to moderate condition and no other risk factors, and who undergo an effective treatment such as CPAP, would not be assessed a surcharge for an existing medical condition and would be considered by some insurers for preferred plus classification, says Hinerman.

When you're getting life insurance quotes, your rates will be set in part by your "risk class," which is defined by an insurer's "underwriting guidelines." (Your policy amount and length are the other pricing factors.) The better your risk class, the lower your premiums. A "preferred plus" classification means you pay less than if you received a "preferred" or "standard" risk classification.

A severe condition with good compliance and no other risk factors could be anywhere from preferred to standard rates. Your rating depends on the severity as measured by your sleep study, says Hineman.

The key is treatment. If you're managing the disease, the payoff isn't just for your health, but in your wallet. "I can't stress enough how important it is to be compliant. If the life insurance underwriters see that you are non-compliant (by not having testing done and not being prescribed a CPAP device), premiums could double, triple and quadruple in price," says Peter Poggioli, sales vice president with the insurance brokerage firm of Betz Financial Advisory. (See: Will a health condition kill your life insurance options?)

Your life insurer will want to review your sleep study test, which your health insurance will most likely cover. If your medical records indicate that you should have a sleep study performed and you haven't done one, some life insurance companies will not consider you for a policy until you do. The test reveals respiratory patterns, chest muscle activity and oxygenation, among other things.

Also top-of-mind for insurers are factors like your age at time of diagnosis, what you're doing for treatment, your blood pressure rate, your weight, whether you are a smoker or not, and other health problems you may have.

Treatment can include weight loss, avoidance of stimulants and alcohol prior to going to bed, avoiding sleeping on your back, and using CPAP or bilevel positive airway pressure (BiPAP). If you go the CPAP or BiPAP route, the best results come from using the devices every night for several hours. There are also surgical options, such as surgery to change the shape of the jaw or the tongue.

Sleep apnea and health insurance

Typically, with group health insurance, individual underwriting isn't performed, which is a distinct advantage if you have sleep apnea.

If you are shopping for individual health insurance, sleep apnea presents more of a challenge. If you have a pre-existing condition, the company can cover you with full benefits immediately, but at a higher rate; put a rider or a limitation on coverage on the condition for a period of time; or deny coverage.

If you have individual health insurance and your insurer rejects a claim related to sleep apnea, you don't have to settle for a "no." You can appeal an insurer's decision. (See: "How to appeal a health claim denial - and win!")Team up with your agent and doctor and discuss whether you want to appeal the decision. A detailed letter from your doctor about your health can help your case. Also, if you can show improvement after treatment -- such as improved blood pressure readings -- it can help you state your case.

When you appeal, it also doesn't hurt to include articles from prestigious journals that trumpet the benefits of your treatment. You might also seek guidance from your state insurance commissioner's office about the appeals process.

Sleep apnea and auto insurance

Sleep apnea affects life and health insurance, but car insurance isn't directly impacted. However, if your sleep apnea causes you to drive poorly and get into accidents, this would lead to high rates.

"Since fatigue is a factor in accidents, sleep apnea can put you indirectly at a higher risk of getting into a car accident," says Scott Hoffman, an agent and principal of the Howard & Hoffman Insurance Agency. A study by the Vancouver Coastal Health Research Institute and the University of British Columbia found that people with sleep apnea are at double the risk of being in a car crash.

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