Saturday, October 23, 2010


In law and economics, insurance is a form of risk management primarily used to hedge against the risk of a contingent, uncertain loss. Insurance is defined as the equitable transfer of the risk of a loss, from one entity to another, in exchange for payment. An insurer is a company selling the insurance; an insured or policyholder is the person or entity buying the insurance policy. The insurance rate is a factor used to determine the amount to be charged for a certain amount of insurance coverage, called the premium. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

The transaction involves the insured assuming a guaranteed and known relatively small loss in the form of payment to the insurer in exchange for the insurer's promise to compensate (indemnify) the insured in the case of a large, possibly devastating loss. The insured receives a contract called the insurance policy which details the conditions and circumstances under which the insured will be compensated.

1. Health insurance

Health insurance, like other forms of insurance, is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses. The collective is usually publicly owned or else is organized on a non-profit basis for the members of the pool, though in some countries health insurance pools may also be managed by for-profit companies. It is sometimes used more broadly to include insurance covering disability or long-term nursing or custodial care needs. It may be provided through a government-sponsored social insurance program, or from private insurance companies. It may be purchased on a group basis (e.g., by a firm to cover its employees) or purchased by an individual. In each case, the covered groups or individuals pay a fee, premium, or tax---to help protect themselves from unexpected healthcare expenses. Similar benefits paying for medical expenses may also be provided through social welfare programs funded by the government.

By estimating the overall risk of healthcare expenses, a routine finance structure (such as a monthly premium or annual tax) can be developed, ensuring that money is available to pay for the healthcare benefits specified in the insurance agreement. The benefit is administered by a central organization such as a government agency, private business, or not-for-profit entity.

2. Accidental death and dismemberment insurance

Accidental Death and Dismemberment (also known as AD&D) is a term used to describe a policy that pays benefits to the beneficiary if the cause of death is due to an accident.

In the event of an accidental death, this insurance will pay benefits in addition to any life insurance held. Some of the covered accidents include traffic accidents, exposure, homicide, falls, heavy equipment accidents, and drowning. Accidental deaths are the fifth leading cause of death in the US[2]. Death by illness, suicide, or natural causes are generally not covered by AD&D. Some insurers will even cover an accidental death caused from war or terrorism.

3. Dismemberment
Fractional amounts of the policy will be paid out if the covered employee loses a bodily appendage or sight because of an accident. Additionally, AD&D generally pays benefits for the loss of limbs, fingers, sight and permanent paralysis. The types of injuries covered and the amount paid vary by insurer and package, and are explicitly enumerated in the insurance policy.

4. Coverage Types

There are four common types of group AD&D plans offered in the United States:
  • Group Life Supplement - the AD&D benefit is included as part of a group life insurance contract, and the benefit amount is usually the same as that of the group life benefit;
  • Voluntary - the AD&D is offered to members of a group as a separate, elective benefit, and premiums are generally paid as a payroll deduction;
  • Travel Accident (Business Trip) - the AD&D benefit is provided through an employee benefit plan and provides supplemental accident protection to workers while they are traveling on company business (the entire premium is usually paid by the employer);
  • Dependents - Some group AD&D plans also provide coverage for dependents.
General information
American General Life and Accident Insurance Company

1. History of American General Life and Accident Insurance Company
American General Life and Accident Insurance Company (AGLA) is committed to serving the needs of today's middle market. We offer a focused, supported approach to provide a secure future for our customers through affordable solutions that help meet a lifetime of financial needs–solutions such as protecting loved ones, bringing college dreams to life and providing for retirement.
We back these solutions with personal customer service, an increasingly sought-after service in the middle-market segment. Competitively priced life insurance, annuity and accident and health products are available to satisfy the financial needs and risk tolerance of our customer base.
2. Our History
American General Life and Accident Insurance Company was incorporated February 28, 1900 under the laws of the State of Tennessee as “The National Sick and Accident Association of Nashville.” The Company became a wholly owned subsidiary of NLT Corporation (NLT) in 1968. In 1982, American General Corporation (AGC), based in Houston, Texas, acquired NLT and its subsidiaries. The Company adopted its current name in 1984.
In 1991, Gulf Life Insurance Company was merged into American General Life and Accident. In 1997, The Independent Life and Accident Insurance Company merged into American General Life and Accident. Also in 1997, Home Beneficial Insurance Company merged into American General Life and Accident.

3. Contact
Questions? Need Help?

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American General Life and Accident Insurance Company
American General Center
MC 338N

Nashville TN 37250

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Friday, October 22, 2010

Symptoms and Diagnosis of Cancer


Cancer is suspected based on a person's symptoms, the results of a physical examination, and sometimes the results of screening tests. Occasionally, x-rays obtained for other reasons such as an injury, show abnormalities that might be cancer. Confirmation that cancer is present requires other tests (termed diagnostic tests). After cancer is diagnosed, it is staged. Staging is a way of describing how advanced the cancer has become, including such criteria as how big it is and whether it has spread to neighboring tissue or more distantly to lymph nodes or other organs.


Screening tests serve to detect the possibility that a cancer is present before symptoms occur. Screening tests usually are not definitive; results are confirmed or disproved with further examinations and tests. Diagnostic tests are performed once a doctor suspects that a person has cancer.

Although screening tests can help save lives, they can be costly and sometimes have psychologic or physical repercussions. Screening tests can produce false-positive results—results that suggest a cancer is present when it actually is not. False-positive results can create undue psychologic stress and can lead to other tests that are expensive and risky. Screening tests can also produce false-negative results—results that show no hint of a cancer that is actually present. False-negative results can lull people into a false sense of security. For these reasons, there are only a small number of screening tests that are considered reliable enough for doctors to use routinely.

Doctors determine whether a particular person is at special risk for cancer—because of age, sex, family history, previous history, or lifestyle—before they choose to perform screening tests. The American Cancer Society has provided cancer screening guidelines that are widely used. Other groups have also developed screening guidelines. Sometimes recommendations vary among different groups, depending on how the groups' experts weigh the relative strength and importance of available scientific evidence.

In women, two of the most widely used screening tests are the Papanicolaou (Pap) test to detect cervical cancer and mammography to detect breast cancer. Both screening tests have been successful in reducing the death rates from these cancers in certain age groups.

In men, prostate-specific antigen (PSA) levels in the blood may be used to screen for prostate cancer. PSA levels are high in men with prostate cancer, but levels also are elevated in men with noncancerous (benign) enlargement of the prostate. As such, the main drawback to its use as a screening test is the large number of false-positive results, which generally lead to more invasive tests. Whether the PSA test should be used routinely to screen for prostate cancer is unresolved, with varying recommendations from different groups. Men over 50 should discuss the PSA test with their doctor.

A common screening test for colon cancer involves checking the stool for blood that cannot be seen by the naked eye (occult blood). Finding occult blood in the stool is an indication that something is wrong somewhere in the gastrointestinal tract. The problem may be cancer, although many other disorders, such as ulcers, hemorrhoids, diverticulosis (small pouches in the colon wall), and abnormal blood vessels in the intestinal walls, can also cause small amounts of blood to leak into the stool. In addition, taking an aspirin or another nonsteroidal anti-inflammatory drug (NSAID) or even eating red meat can temporarily produce a positive result. Positive results on the most commonly used test can occasionally be caused by consuming certain raw fruits and vegetables (turnips, cauliflower, broccoli, melons, radishes, and parsnips). Some people with blood in the stool may have negative test results because they have consumed vitamin C. Newer screening tests for occult blood that use a different technique are much less susceptible to such errors but are somewhat more costly. Outpatient procedures such as sigmoidoscopy and colonoscopy are also often used for colon cancer screening.

Some screening tests can be done at home. For example, monthly breast self-examinations may help women detect breast cancer. Periodically examining the testes may help men detect testicular cancer, one of the most curable forms of cancer, especially when diagnosed early. Checking the mouth for sores may help detect mouth cancer in an early stage.

Cancer Screening Recommendations
Procedure Frequency
Skin cancer
Physical examination Should be part of a routine checkup; more frequent examinations may be needed for people at high risk for developing skin cancer
Whole-body photography Not routinely needed; may be helpful for people with multiple moles or in whom examination of the skin is difficult
Lung cancer
Chest x-ray Not recommended on a routine basis
Sputum cytology Not recommended on a routine basis
Low-dose spiral computed tomography Not recommended on a routine basis, but is under investigation
Rectal and colon cancer
Stool examination for occult blood Yearly after age 50†
Sigmoidoscopic or colonoscopic examination
Every 5 years beginning at age 50 (sigmoidoscopy)†
Every 10 years beginning at age 50 (colonoscopy)
Prostate cancer
Rectal examination Yearly after age 50
Blood test for prostate-specific antigen Yearly after age 50
Cervical cancer
Papanicolaou (Pap) test Annual regular Pap test (or newer liquid-based Pap test every 2 years) beginning between ages 18 and 21. Some women 70 years of age or older who have had 3 or more normal Pap tests in a row may choose to stop having cervical cancer screening. For women over 30, some doctors recommend testing every 3 years with a conventional Pap test plus the human papillomavirus DNA test
Breast cancer
Breast self-examination Consider monthly self-examinations after age 20
Breast physical examination by health care provider Every 3 years between ages 20 and 39, then yearly
Mammography Yearly, starting at age 40
*Recommendations for screening are influenced by many factors. These screening recommendations are for asymptomatic people with an average risk of cancer. For people with a higher risk, such as those with a strong family history of certain cancers or those who have had a previous cancer, screening may be recommended more frequently or to start at a younger age. Screening tests other than those listed here may also be recommended. Furthermore, other organizations, such as the U.S. Preventive Services Task Force, may have slightly different recommendations. A person's physician can help the person decide when to begin screening and which tests should be used.
†The combination of yearly stool examination for occult blood and sigmoidoscopy every 5 years is preferred over either of these options alone.

Diagnostic Tests and Staging


Usually, when a doctor first suspects cancer, some type of imaging study, such as x-ray, ultrasonography, or computed tomography (CT), is performed. For example, a person with chronic cough and weight loss might have a chest x-ray; a person with recurrent headaches and trouble seeing might have a CT scan or magnetic resonance imaging (MRI) of their head. Although these tests can show the presence, location, and size of an abnormal mass, they cannot confirm that cancer is the cause. Cancer is confirmed by finding cancer cells on microscopic examination of samples from the suspected area. Usually, the sample must be a piece of tissue, although sometimes examination of the blood is adequate (such as in leukemia). Obtaining a tissue sample is termed a biopsy. Biopsies can be performed by cutting out a small piece of tissue with a scalpel, but very commonly the sample is obtained using a hollow needle. Such tests are commonly done without the need for an overnight hospital stay (outpatient procedure). Doctors often use ultrasonography or a CT scan to guide the needle to the right location. Because biopsies can be painful, the person is usually given a local anesthetic to numb the area.

In people with findings on examination or imaging tests that suggest cancer, measuring blood levels of tumor markers may provide additional evidence for or against the diagnosis of cancer. In people who have been diagnosed with certain types of cancer, tumor markers may be useful to monitor the effectiveness of treatment and to detect possible recurrence of the cancer. For some cancers, the level of a tumor marker drops following treatment and increases if the cancer recurs

Selected Tumor Markers
Tumor Marker
Comment About Testing
Alpha-fetoprotein (AFP) Levels may be raised in the blood of people with cancer of the colon. Blood levels may also be elevated in patients with other cancers or noncancerous conditions. Testing can be useful in diagnosing these cancers and in monitoring treatment.
Beta-human chorionic gonadotropin (ß-HCG) This hormone is produced during pregnancy but also occurs in women who have a cancer originating in the placenta and in men with various types of testicular cancer. Testing can be useful in diagnosing such cancers and in monitoring treatment.
Beta22)-microglobulin Levels may be raised in people with multiple myeloma or other cancers of blood cells. This test cannot be recommended for cancer screening.
Calcitonin Produced by certain cells in the thyroid gland (C cells). Blood levels elevated in medullary thyroid cancer. May be used to monitor response to treatment of medullary thyroid cancer.
Carbohydrate antigen 125 (CA-125) Levels may be increased in women with a variety of gynecological diseases, including ovarian cancer. This is not recommended for routine cancer screening.
Carbohydrate antigen 19-9 (CA 19-9) Levels may be increased raised in people with cancers of the digestive tract, particularly pancreatic cancer. This test cannot be recommended for cancer screening.
Carbohydrate antigen 27.29 (CA27.29) Levels may be increased in people with breast cancer. This test cannot be recommended for cancer screening.
Carcinoembryonic antigen (CEA) Levels may be raised in the blood of people with cancer of the colon. Blood levels may also be elevated in patients with other cancers or noncancerous conditions. After surgery for colon cancer, testing can be useful in monitoring treatment and detecting recurrence.
Lactate dehydrogenase Levels can be raised for a variety of reasons. This test cannot be recommended for cancer screening. However, it is useful in assessing prognosis and monitoring treatment, particularly for people with testicular cancer, melanomas, and lymphomas.
Prostate-specific antigen (PSA) Levels are raised in men with noncancerous (benign) enlargement of the prostate and often are considerably higher in men with prostate cancer. What constitutes a meaningfully abnormal level is somewhat uncertain, but men with an elevated PSA level should be evaluated further by a doctor. Testing can be useful in screening for cancer and in monitoring its treatment.
Thyroglobulin Elevated blood levels may occur in patients with thyroid cancer or benign thyroid conditions. This test cannot be recommended for routine screening but may be helpful for monitoring response to treatment of thyroid cancer.
*Because tumor markers can also be produced by noncancerous tissue, doctors generally do not use them to screen healthy people. Exceptions may include PSA for prostate cancer and AFP for patients at risk for hepatoma. In families with inherited medullary thyroid cancer, a rare condition, calcitonin blood levels also may be a useful screening test.


When cancer is diagnosed, staging tests help determine how extensive the cancer is in terms of its location, size, growth into nearby structures, and spread to other parts of the body. People with cancer sometimes become impatient and anxious during staging tests, wishing for a prompt start of treatment. However, staging allows doctors to determine the most appropriate treatment as well as helping to determine prognosis.

Staging may use scans or other imaging tests, such as x-ray, CT, MRI, bone scintigraphy, or positron emission tomography (PET). The choice of staging test(s) depends on the type of cancer, as different cancers involve different parts of the body. CT scanning is used to detect cancer in many parts of the body, including the brain and lungs and parts of the abdomen, including the adrenal glands, lymph nodes, liver, and spleen. MRI is of particular value in detecting cancers of the brain, bone, and spinal cord.

Biopsies are often needed for staging and can sometimes be done together with the initial surgical treatment of a cancer. For example, during a laparotomy (an abdominal operation) to remove colon cancer, a surgeon removes nearby lymph nodes to check for spread of the cancer. During surgery for breast cancer, the surgeon biopsies or removes lymph nodes located in the armpit to determine whether the breast cancer has spread there; this information along with features of the primary tumor helps the doctor determine whether further treatment is needed. When staging is based only on initial biopsy results, physical examination, and imaging, the stage is referred to as clinical. When the doctor uses results of a surgical procedure or additional biopsies, the stage is referred to as pathologic. The clinical and pathologic stage may differ

In addition to imaging tests, doctors often obtain blood tests to see if the cancer has begun to affect the liver, bone, or kidneys.

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Aids diabetics with peer support

Pairing people with diabetes who are struggling to control their blood sugar levels with their peers for weekly support sessions could be an effective and inexpensive way to help manage the disease, researchers say.

Such a program was linked with significantly reduced blood sugar levels in male veterans with diabetes, according to a new study appearing in the Oct. 19 issue of the Archives of Internal Medicine.

The authors initially identified almost 1,700 veterans who might be eligible for the trial, but were only able to enroll 244. The 200-plus participants, all male, were randomized either to be matched up with another diabetes patient for weekly peer support and the option of attending group sessions, or to undergo one educational training and then receive care from a nurse care manager. 

According to study author Dr. Michele Heisler, this model of peer support is less hierarchical than most systems in the United States.

“We explicitly wanted to test whether patients who were having self-management challenges and … [who] had dangerously high blood sugar levels over the prior three months … might be better motivated themselves if given the opportunity to both help and receive help from another participant facing similar self-management challenges and who also had poor control,” explained Heisler, who is a research scientist with the Center for Clinical Management Research at the Ann Arbor VA. 

This appeared to be the case: Men in the peer-support group saw a significant drop in their HbA1c levels (a measure of blood sugar over time) — from an average of 8.02 to 7.73 percent over six months, which represented a 0.58 percent decrease from those in the control group, who received care from a nurse. 

“That is equivalent to adding a new oral anti-hyperglycemic medication and a very clinically significant difference,” said Heisler, who is also associate professor of internal medicine and health behavior and health education at the University of Michigan Medical School. 

Blood pressure dropped slightly (although not significantly) in both groups, and no adverse effects were noted in either. Eight patients in the peer group also started on insulin during the trial, as opposed to just one in the control group, indicating that peer support may also be instrumental in convincing often-resistant patients to initiate insulin therapy, the authors stated. 

Further study is needed to tease out which parts of a peer group intervention are most successful, concluded the authors, who noted that their research was limited in that it involved only men, lasted just six months, and was not a double-blind study.

In addition to the weekly telephone calls, patients in the peer group met about four-and-a-half hours more than those in the control group, which probably accounted for at least some of the improvement, said Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. 

“In diabetes, every time we spend more time with the patient – it could be a [nurse], a physician, or a Johnny-do-gooder, it reminds the patient to do something or to be more engaged,” he said. “The outcomes short-term tend to be better.”

Zonszein pointed out that almost 1,000 veterans contacted declined to participate, a fact which he said may not bode well for the success of this type of system in the real world.

However, he said, such programs may “play a role, especially in minority populations where either language or ethnicity is very different from our traditional American population. They really help the bridging between health-care providers.”

Peer educators may “almost be better suited for [certain] important ingredients of diabetes self-management,” added Sharon Movsas, a certified diabetes educator who, like Zonszein, is with Montefiore Clinical Diabetes Center. “The patient needs to feel empowered and confident… It’s not so much knowing what to eat but ‘how am I going to change my behavior?’ That involves problem-solving and goal-setting skills and the evidence shows that … the person can relate better to a peer who might have more similarities than a teacher in the front of the room.”

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Harvard lawyer Write "Fight Less, Love More"

Harvard lawyer and couples mediator Laurie Puhn has written Fight Less, Love More: 5-Minute Conversations to Change Your Relationship without Blowing Up or Giving In. As Puhn explains, “Many of my clients have these foolish disagreements with their partner but they don’t realize it until I point it out to them." Below, an excerpt of her book reveals two common types of arguments couples often have--and how to avoid them the healthy way.

1. The Dumb Premature Argument
Hector and Maria live in an apartment but hope to buy a house someday. Every time they visit a friend who lives in a house, their drive home provides ample time for squabbling about whether they should buy a ranch-style home like the one Maria grew up in or a two-story colonial like the one Hector’s family had. They argue vehemently about the pros and cons of each style, but the silly thing is, they aren’t planning to move out of their apartment until their toddler is ready for kindergarten, at least 3 years from now. Even if they managed to argue their way to a decision now, in all likelihood they would have to reargue the same issue in 3 years anyway, because people’s preferences, incomes, and family situations change over time.

The Wise Tactic
If the outcome of any argument can’t be acted upon for a long time, it’s a dumb premature argument. As much as you might want to voice your side now, you’ll only be wasting time and energy—and adding unnecessary conflict to your relationship. When you realize that you’re arguing about something that doesn’t need an immediate decision, it’s wise to short-circuit the fight by saying, “Why don’t we wait to have this discussion until we actually need to?” In the case of Hector and Maria, one of them simply needs to say, “Why are we wasting our time arguing about this now? Let’s make a pact not to debate our design preferences until we’re actually ready to buy a house!” This will give your partner the ability to retreat gracefully with a comment like “That’s a good idea. I don’t know why we started talking about this now anyway.”

2. The Dumb Factual Argument

My husband and I were driving to a 99¢ store to buy some party supplies. I mentioned, “You know, a lot of these so-called 99¢ stores charge more than 99¢ for many of the items they sell.”
“Not possible,” he said. “All 99¢ stores sell everything at that price. That’s why they’re called 99¢ stores.”
“That’s not true. You don’t know because you haven’t been to one. The 99¢ thing is just a way to get more people into the store,” I explained.
“Why would they call it a 99¢ store if it’s not one?” he shot back, still trying to convince me.
“Wait a minute,” I blurted out. “This is a dumb argument. We’re arguing about a fact. Why don’t we just hold on for 10 minutes, get to the store, and we’ll have our answer?” He agreed, so we shut our mouths and found the answer in the store. (I was right!).

The Wise Tactic:
Have you ever found yourself getting agitated because your partner says you’re wrong when you’re sure you’re right? Or have you found yourself trading “It’s true” and “No, it isn’t” until you’re both blue in the face? Those are all familiar set-up words for the dumb factual argument. Instead, when you are bickering about a fact like an address, a name, or a statistic, recognize this and say, “Hey, we’re arguing about a fact. Let’s just find out the information instead of fighting about it.” In less than 5 minutes, you’ll have your answer and avoid an argument over nothing.

The 5-minute Conversation: Short-Circuit a Dumb Argument

1. Admit Your Error
Switch gears as soon as you realize you shouldn’t have picked this foolish battle. Recognize that you are engaged in a premature argument or arguing about a fact, or any of the other common tiffs I discuss in my book Fight Less, Love More. Then, hold up your hands as if to surrender and admit your error with a simple comment that identifies why you’re having a dumb argument. For example, you could say, “Wait a second. I shouldn’t have said that. This is silly because we are having a dumb argument about something that’s a fact.”

2. No Buts About It
If your mate doesn’t want to short-circuit the argument and tries to continue with a comment like “But just let me explain,” let him or her talk and then short-circuit the potential argument again by saying, “Well, that could be, but there’s no point in debating it.” Just keep up that response and your partner will eventually have to let the argument go.

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