How do insurance companies test for tobacco use?

May 20, 2013 1:14 PM

Someone asked me this this morning, and I have no idea so I thought I would throw it out to the green.

I was asked: "In every insurance application I have ever filled out, there is a question about cigarette smoking, and smokers are charged higher rates to reflect the higher rates of related health issues. How do insurance companies test for smoking? I am sure insurance companies have ways to figure out if you've lied on the application so they can find a reason to deny your claims, but what are they? Are there ways to get around the test results as there are with marijuana tests?"

For the record I am not encouraging anyone to smoke, or to commit insurance fraud by lying about smoking - I am wondering about this because I have never thought of it myself before today.

Thanks!

posted by deliciae to Health & Fitness (8 answers total)

For life insurance, for both my husband and myself, we had to schedule an appointment with a nurse who came to our house to draw our blood, take our blood pressure and weight.
We were told the blood tests where to determine if we were smokers.

Our life insurance is through Northwestern Mutual if it makes any difference.
posted by ejazen at 1:16 PM on May 20, 2013

I've been tested for tobacco by an insurance company via mouth swab.
posted by something something at 1:19 PM on May 20, 2013

They test for nicotine.
posted by three blind mice at 1:21 PM on May 20, 2013

From what I have been able to gather from my health assessments for work, they test for the presence of something called cotinine. It is a metabolic byproduct of nicotine and it does not appear it can be gamed, as it stays in your system for several days.
posted by calistasm at 1:28 PM on May 20, 2013 [1 favorite]

Another way they "test" for it is later, when they are trying to not pay a claim.

Say you get lung cancer. Well, they comb through your medical records for any mention of a conversation with your doctor about "smoking cessation" or "patient admits to smoking x cigarettes/day."

So if they find evidence of smoking in your medical history, they'll retroactively invalidate your insurance. And congratulations, now you have no health insurance.

Not that admitting to being a smoker is any guarantee that an insurance company is going to pay the claim. Or that their maximum liability is going to come even close to covering the cost of care.
posted by bilabial at 1:32 PM on May 20, 2013

I have an individual policy, and they did not test for smoking. In fact, I took no tests at all and did not see a doctor, so everything was just on the honor system (with BlueCross/BlueShield). However, if they find out you lied about anything at all, then the entire policy is cancelled and you don't get your money back. See stories about Robin Beaton for additional fear.
posted by Houstonian at 2:04 PM on May 20, 2013

Best answer: Yes, it's usually a mouth swab for cotinine. While nicotine has a half life of something like 7 minutes, cotinine stays around much longer. You could abstain from tobacco for 24 hours and pass a nicotine test, but you'd have to abstain for a week or more to pass a test for cotinine. (I think- it's something like that.) Since the only way to have an appreciable blood level of cotinine is metabolizing nicotine, it's pretty foolproof. To the extent it proves whether someone has used nicotine in the last X days. It can't prove you won't immediately eat a cigar after the test.

*Whether* they test is a different story. An individual policy probably will. But if you are in a group policy, they don't really much care. They know that 18% of the population smokes, and from their perspective, they really don't care which individuals are in that group. They will try to get that number down via other means.
posted by gjc at 7:26 PM on May 20, 2013 [1 favorite]

Best answer: Also can be done as a urine test -from Quest labs test website:

Cotinine derives from nicotine. Once absorbed in the body, nicotine rapidly metabolizes to cotinine and cannot be detected in significant quantity in the urine. The half life of nicotine is short, about two hours. The half-life of cotinine is 10-37 hours which makes it a more reliable marker than nicotine. Cotinine, intrinsically being specific for tobacco, is the preferred marker for use of tobacco. Tobacco is the leading cause of death in the United States
posted by citygirl at 9:11 AM on May 21, 2013