Quitline NRT Services and Insurance Surcharge – 5/16/05

Q: My state has a $20 surcharge per month for tobacco users, and I learned that Georgia recently passed a $40 surcharge. I was wondering if anyone has found a way to offer quitline services with NRT for an insurer without having to identify the tobacco user?

A:

1. Michigan: If the NRT is going to be paid for by the insurer then I don't think there is a way to hide the NRT user's identity. The insurer needs to know who is making a claim. If the state wants to give out free NRT, then the insurer doesn't need to be involved.
   
   I haven't read the Georgia legislation but this is a concerning situation! If insurers are going to be allowed to "punish" people seeking treatment by tacking on a surcharge then this type of legislation is going to backfire. I assume the intent of the legislation is to reduce smoking and encourage quitting rather than simply punishing smokers who are obviously intending to quit. If the language of the legislation allows employers and insurers to label those who obtain NRT as smokers who should be surcharged, then we are all going to have big problems down the road.
   
   We (all the states) need to get some sample bill language that defines how a smoker will be identified to insurers, a grace period for smokers who want to quit before the surcharge becomes effective, and a method to identify when a successful quit has been accomplished so that the surcharge can be removed.
   
   I would recommend to Georgia and the other unnamed state in your email, that they go over the legislation to see if there are any of these types of treatment clauses. If there are no exceptions then, I would recommend that one or two people from the state health department set up a meeting to talk to the sponsoring legislator and ask him/her about the intent of the bill. Ask either for the authority of the health dept or the state insurance administrator to grant a surcharge exemption to those making a quit attempt or to ask the legislator to go back and amend the bill to include an exemption.
   
   The substance abuse agencies in these states (and SAMHSA) may also have some great advice to address this issue and to suggest appropriate bill language as they would have dealt with similar situations in alcohol and drug treatment. Your insurers may be good partners to help with the language too as it is in their best financial interest to have their clients quit. Your insurers are probably not going to like a bill that discourages seeking treatment for an unhealthy behavior. I imagine AHIP (www.ahip.org) would be interested in this legislative development.
    
2. Texas: Not yet - we have a limited supply of NRT that we are providing to
   patients in a specific geographic area or those referred by physician fax
   referral, but we do not have a way set up with insurers.
    
3. West Virginia: Haven’t found a way yet.
    
4. Wyoming: The answer is to just offer the service. The insurance companies can have separate contracts with the Quitline.

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