Anthem Blue Cross/Blue Shield Thinks Smoking And Depression Are Basically The Same Thing

Wellbutrin is an atypical antidepressant used to treat patients with depression, but it’s also effective when used short-term to help people quit smoking. As far as Anthem Blue Cross/Blue Shield is concerned, then, if you’re using Wellbutrin, you’re a smoker. For people whose health insurance comes from their employers, this isn’t as much of a problem. But the individual health insurance market is a cruel, unforgiving place where smokers pay higher premiums. And so reader Elizabeth’s husband, who quit smoking more than four years ago, is slapped with the smoker’s rate because he has a prescription for Wellbutrin, which they consider an “atypical tobacco product.”

According to Anthem/BlueCross BlueShield, quitting smoking won’t help you lower your health insurance premiums, especially if you use an anti-depressant to do it.

I finally trimmed our budget enough to purchase adequate health insurance for my husband. We found a great rate through Anthem/BCBS via eHealthInsurance.com and immediately applied.

The estimate was about $89 per month and covered all the preventative care we wanted. Obviously, I expected the premium to be higher than the estimate and budgeted accordingly. I was shocked when we received the bill and saw the premium was $137 per month – over 50% more than the initial estimate.

Upon calling Anthem, we were told that my husband received a poor health grade because the phone interview notes listed him as a smoker. When we explained that my husband hasn’t had a cigarette since November 2007, the agent advised us to submit a Statement of Appeal, requesting the grade be reviewed based on my husband’s non-smoking status.

Our appeal was denied on the grounds that my husband takes Wellbutrin – a medication that Anthem considers to be an alternative tobacco product. According to the underwriter my husband contacted, the ruling that “Wellbutrin = tobacco” had come from a high level consultant and could not be appealed.

When my husband asked if he could change to a different medication, he was told that any anti-depressant would result in the same grade reduction and rate hike.

In short, Anthem/BCBS considers taking an anti-depressant an equivalent health risk to smoking cigarettes. Perhaps they think that balanced brain chemistry causes lung cancer?

That’s it! Non-smoking Wellbutrin patients are too balanced for their own good!

Here, for the record, is the exact text of that letter sent after the unsuccessful appeal:

Dear Mr. [redacted]

We have received additional information that you submitted for us to reconsider our decision regarding your application for individual health care coverage.

Although careful consideration has been given, we regret we are still unable to grant your
request. This decision was based on Other Tobacco Products such as Wellbutrin is Used for Smoking Replacement.

We appreciate your interest in our services. If you have any questions, please contact your
agent or an Underwriting representative at 1-866-282-2157 for further assistance.

Comments

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  1. Lyn Torden says:

    Sue them … both … including the “high level consultant” (name then “John Doe” until discovery process reveals their identity).

    • bhr says:

      Sue them for what exactly? On what grounds can you sue someone in this situation? what is her actual damages (She can find insurance somewhere else, even if she had to pay more).

      • kc2idf says:

        “what is her actual damages (She can find insurance somewhere else, even if she had to pay more). “

        Actual damages: The lesser of:
        – $48 times the number of months or
        – A premium from another insurer that is more than $89 but less than $137
        …times the number of months that this charade carries on, plus compensation for time wasted arguing with BCBS, plus court costs.

        Should fit into small claims nicely.

        • bhr says:

          While I am not an attorney (neither are you obviously) I am not sure you have the ability to sue for a company setting prices based on whatever criteria they want. You definitely can’t sue to the time you spent arguing.

          • Loias supports harsher punishments against corporations says:

            Yes you can, in fact, sue for time lost. Time = money, and that tactic is done all the time.

            All.

            The.

            Time.

            • bhr says:

              Nope. you also can’t sue for pain and suffering in small claims court (at least in the three states I have dealt with). Losses have to be real and tangible.

          • Tyanna says:

            You can sue a company b/c your toast was burnt this morning. There is nothing stopping you from suing anyone.

            The question isn’t ‘can they sue’ b/c that is always yes. The question is ‘can they win?’ or ‘will it help?’

            That is up to the parties to decide.

          • longfeltwant says:

            Your answer ignores the fact that health insurance is highly, highly regulated. I’d be surprised if there were no legal claim in this situation.

            • Nigerian prince looking for business partner says:

              It may be highly regulated but for the most part, insurers are free to set their own underwriting guidelines, as long as they are submitted to the state in advance.

              In my state, only about 4% of applicants are eligible for the prime, quoted rates for a major insurer, like Bluecross. We just went through this back in December.

    • PHRoG says:

      Bingo!

    • Loias supports harsher punishments against corporations says:

      I have to agree. This is clearly a way to simply charge higher premiums.

    • nearly_blind says:

      Is this what masses believe?
      Although they’re highly regulated medical insurance companies are private companies (this is what brilliant American voters want). It’s one thing for an insurer to reject a claim by an existing customer who has a contract with an insurer, e.g. they won’t pay for treatment X (this falls under contract law); however, the OP is complaining about not liking the rate offered to her in a proposed contract. Unless the state or federal government law or regulations specifically forbid it, any business is free to quote a price based on anything they want. The reasons don’t have to be valid and don’t have to be disclosed.

      If I to quote you a higher price for mowing your lawn because you wear red shoes, then tough luck; you don’t have grounds for a lawsuit.

      Medical insurance companies are highly regulated by individual states and soon by the federal goverment. Depending on the state these regulations may include what factors they may use in determining rates; however, unless the laws that established the regulations provided for individuals to sue for specific penalties (not likely), then the only recourse would be for people to complain to their State, who could then force the insurer to change their policies or fine them (money to state).

      • Nigerian prince looking for business partner says:

        I think most people are just used to group insurance through work and have no experience with the individual market.

        They don’t really understand that while baseline rates have to be approved a state’s insurance commission, insurers are free to adjust rates based on sub-prime health status, exclude pre-existing conditions, or deny policies all together. For many policies, less than 10% of the population is eligible for prime rates.

        I really don’t think pushing the smoking issue is a good idea. They could very well remove the smoking adjustment and then adjust it more for mental health issues or reject future mental health claims as a pre-existing condition. In the current situation, a mental health history has already been disclosed prior to underwriting and claims can’t be retroactively denied. Many insurers wont touch someone with a mental health history with a 10 foot pole and applications are immediately rejected. All they see when the “Depression” box is checked is a 6-figure claim for a liver transplant from a failed suicide attempt.

        This is part of the reason why I went through a local broker who has been down this road before and is familiar with the underwriting guidelines for various insurers. Applying for insurance can be incredibly complicated.

  2. AustinTXProgrammer says:

    To be fair the Insurance company should have a former smokers rate based on the years of smoking/non smoking. The OP is a much higher risk than someone who never smoked.

    If the anti depressant is being taken as a result of a stop smoking program and not for clinically diagnosed depression I think BCBS has a point.

    • Cat says:

      If you’re still on Wellbutrin 4 years after quitting, it’s not because you’ve quit smoking anymore.

    • longfeltwant says:

      Just to be perfectly clear, smokers have LOWER lifetime medical cost than non-smokers (because they tend to get sick and die, thus not requiring health care into old age). Charging smokers higher prices is absolutely, positively a moral calculation, not a financial calculation.

      • Nigerian prince looking for business partner says:

        Lifetime medical costs are entirely different subject than anticipated medical costs for a given plan year. An insurance company only cares about your given risk for a 12 month period until your policy is renewed.

    • Theoncomingstorm says:

      As I recall, the risks of a former smoker are nearly the same as a life time non-smoker after about five years.

  3. Admiral_John says:

    This is total BS… I wonder if the appeal involved the review of any of the husband’s medical records? If not, maybe the husband needs to get with his doctor and have documentation submitted that the Wellbutrin is to treat documented clinical depression.

    • Brontide says:

      Right, so they can still deny them and now the next insurance company will deny them any coverage for his “documented pre-existing condition” ( which will cover nearly anything they wish ).

    • Nigerian prince looking for business partner says:

      When we applied for insurance through Anthem, we had to supply all of our medical records for a 10 year period, supplemented by attending physician statements for any pre-existing conditions.

  4. bhr says:

    I wonder what the timeline for his smoking history vs. his wellbutrin usage is? If the date when he admitted to quitting smoking was close to the date he started on the antidepressant it actually would make sense that they connected the two.

    I ask because i never smoked but take an antidepressant and never had any sort of smokers’ penalty assessed.

    • Cat says:

      Is your insurer Anthem Blue Cross?

      • bhr says:

        No, and I am not saying their decision was right. I am just wondering how they could have made the connection to smoking. I find it difficult to believe that anyone on antidepressants would be considered to have been smokers, and am curious what triggered this ruling.

        Here is the thing, I have no problem with insurance companies charging more for people with risk factors. I am quite a bit overweight and realize that I pose a higher risk factor than someone with a similar lifestyle but with a lower BMI, and have no problem paying a higher premium.

        We have a problem with insurance in this country, as people feel it should be cheap/fee and all inclusive (like NHS) but that isn’t how insurance works. Car/Life/Homeowners Insurance works because ideally people pay in more than they will reasonably ever collect, thus providing a fund for those who need it. While I think most health insurance companies have serious administrative and ethical issues as long as we have private insurers in this country they are right to be selective/critical in their evaluations of premiums.

        (Again, just talking about the premium side here, I definitely don’t agree with denying coverage after it starts over pettiness, or refusing to pay for treatment due to a technicality)

        • Not Given says:

          Wellbutrin the antidepressant = Zyban the stop smoking drug. I think my copay would be higher for the Zyban even though it is the same drug.

    • Nigerian prince looking for business partner says:

      Did you have a penalty assessed for the depression or was treatment excluded for a certain waiting period?

      We just switched insurers and for pre-existing conditions, we had the option of paying higher premiums to have them covered or having them excluded for a 12 month period. Ours were pretty minor, so it was just easier to exclude them. With a $10,000 deductible, it’s not like it matters either way.

  5. Cat says:

    Her husband needs to stop taking anti depressants and just be miserable like the rest of us.

  6. msbask says:

    He quit smoking over four years ago using Wellbutrin, but is still taking Wellbutrin? Why?

    • K-Bo says:

      Where does it say he took it to quit smoking?

      • Snowblind says:

        First sentence of the letter:

        “According to Anthem/BlueCross BlueShield, quitting smoking won’t help you lower your health insurance premiums, especially if you use an anti-depressant to do it. “

        Since that is not a consumerist editor opining, it is Elizabeth’s own words, we can assume that is what he took it for.

    • witeowl says:

      No. He quit smoking four years ago and was/is currently taking Wellbutrin to treat an unrelated issue: depression.

      • AustinTXProgrammer says:

        That seems implied in the letter, like what the OP wants us to infer it without actually saying it. This makes me consider the possibility they were trying to stick to the facts the OP wanted to present and leave out the details that don’t support the complaint.

        Now Wellbutrin can’t possibly be as bad as Tobacco. Hence why I think there needs to be a former smokers rate.

        • witeowl says:

          I’ll paraphrase Cat: If you’re still on Wellbutrin four years after quitting smoking, you’re no longer taking it to quit smoking.

      • msbask says:

        “According to Anthem/BlueCross BlueShield, quitting smoking won’t help you lower your health insurance premiums, especially if you use an anti-depressant to do it. “

        Doesn’t that mean he’s still taking the Wellbutrin for the smoking?

        • witeowl says:

          Yeah, I’ll confess: I missed that when I read. That is a possibility. In that case, I think the doc’s a dope. Taking an anti-depressant for four years for smoking is beyond off-label use.

  7. RogerX says:

    I’m deeply offended. That you can get health insurance for two people for $89 a month, when between us, my employer and I pay $1150 a month for the same thing.

    • Fubish says: I don't know anything about it, but it seems to me... says:

      Why is you offended, Bunky? Is Anthem Blue Cross your insurer?

    • Cat says:

      I pay more than $137 per WEEK to Anthem for a family policy through my employer, after their contribution.

      “Single Payer”. That is all.

    • sponica says:

      maybe it’s a HDHP health plan….those can be fairly inexpensive. my mom purchased a family HDHP when she was between jobs and it was about 100 dollars a month, granted that was nearly 20 yrs ago

    • Nigerian prince looking for business partner says:

      If it’s a non-group policy for that amount, it almost assuredly has somewhere between a $5,000 – $10,000 deductible.

  8. SpendorTheCheap says:

    “But the individual health insurance market is a cruel, unforgiving place where smokers pay higher premiums.”

    So cruel.

    So unforgiving.

    You want to know who the health insurance market is “cruel” and “unforgiving” to? A healthy person.

    • longfeltwant says:

      Hardly! A healthy person pays no more than an unhealthy person, AND DOESN’T HAVE TO SUFFER POOR HEALTH. Are you saying you would rather pay the same as a healthy person, but you would rather be sick while doing it? That’s pretty weird.

      People who say what you say are wags, idiots, spouting nonsense, having never thought about the situation. If a healthy person wants to save money, he can simply forego insurance. If he wants insurance, then he should be quite thrilled to participate in the system, which manages his risk, and also gets to enjoy good health! I, by the way, am exactly that kind of person. Being healthy is awesome! And if I ever do get sick, then that risk is covered. It’s the best of both worlds.

  9. Dallas_shopper says:

    Single-payer system.

  10. McRib wants to know if you've been saved by the Holy Clown says:

    It’s called the State Board of Insurance (or something like that depending). Contact them. They’d be glad to know Anthem is charging non-smokers smoking rates.

    I suspect that will also magically cause them to reverse the ‘consultant’s’ decision.

    • MaxH42 thinks RecordStoreToughGuy got a raw deal says:

      Precisely what I came here to say. Depending on what state you’re in, they can be very helpful. If nothing else, the OP should CC any complaint they send to their insurer to their state insurance commissioner, that will make them actually read it rather than just laugh and put it in the circular file.

      http://www.naic.org/state_web_map.htm

  11. witeowl says:

    Any anti-depressant would result in the same rate hike? Even Prozac, a SSRI which works completely differently from Wellbutrin (a NRI/DRI)? That’s makes this even more inane.

  12. ElleAnn says:

    Would a doctor’s note help?

  13. bender123 says:

    Ask for a nicotine test. This is standard in underwriting and the husband likely has previous smoking in his medical records. On most claim systems, these two will link for obvious reasons. The easiest thing to do is to request a nicotine/cotinine test and request a physician call to the insurer to confirm the non-smoking reason for the Rx.

  14. jvanbrecht says:

    I always thought Wellbutrin was an asthma drug…

  15. hennese says:

    Simply put – Welbutrin is an anti-depressant. “Zyban” – the exact same drug, with a different name, is for quitting smoking. If he were taking the drug to quit smoking, legally it needs to be Zyban. If it is for Wellbutrin, then it is NOT for quitting smoking. My doctor had to specifically write mine for Zyban when I took it. I think there might be something illegal if the Insurance company’s policy is to call Wellbutrin users smokers. Might want to call the state insurance board and ask them what their opinion is of Wellbutrin users.

    • sponica says:

      and if I remember my psychopharm class….zyban has a lower dosage than wellbutrin.

      although quite honestly, wellbutrin scares me…my ex took it and his late night convulsions and seizures were so much fun

      • hennese says:

        Same drug, different dosage. I think Zyban had different dosages available too – the point is, chemically it is the same drug. The insurance company is just wrong – plain and simple.

        • MrEvil says:

          Most anti-depressants are offered in varying dosages. Physicians start patients on small doses initially and ramp up over the course of several weeks to the maximum appropriate dosage.

      • Darsynia says:

        Welbutrin saved my life. I’d been deeply suicidal and finally got some help, and the night before the Welbutrin kicked in (I can’t remember if it takes a while to build up or if I just started it the next day), I’d had a long conversation with a friend about wanting to die. The next day, I felt much better, and that same friend became drastically depressed, contacting me and suggesting a suicide pact.

        Again, Welbutrin saved my life–and I think that my responses over those three hours before he went to bed saved his.

        • sponica says:

          I know it works in some people (especially in those who don’t respond to SSRIs or who have manic symptoms with depression)….and it’s one of the few antidepressants that doesn’t tend to kill the sex drive, but some of the side effects I find scary as an observer. my ex definitely had a smoking problem, but I didn’t think his mood needed tinkering with and I would have preferred the smoking to the night-time seizures that he didn’t realize were happening but always woke me up.

          I can’t remember how wellbutrin works in the brain….I know with SSRIs the chemical change is immediate but it takes 4 to 6 weeks for there to be a therapeutic effect. I also don’t remember the placebo effect rates for either meds.

          • Darsynia says:

            Oh definitely, I just wanted to offer a positive alternative to ‘it causes seizures,’ heh. My own mother got worse (much more miserable, crying for no reason, etc.) while on it, she was really worried when I said I was going to try it, heh. It’s definitely not a drug everyone can benefit from.

    • Velifer says:

      Show me where off-label prescribing is illegal.
      Oh, you can’t find that anywhere? I’m shocked! SHOCKED!

  16. thomwithanh says:

    I’m assuming your doctor may have submitted a statement to the insurance co during the appeal? There has to be a way to escalate this, maybe an ECCB?

  17. Nigerian prince looking for business partner says:

    “I finally trimmed our budget enough to purchase adequate health insurance for my husband. We found a great rate through Anthem/BCBS via eHealthInsurance.com and immediately applied.”

    I had much better luck using a local broker, supplemented with information from healthcare.gov. For Anthem, I recall seeing that only 4% of customers were given the initially quoted rates and 40% were denied all together.

  18. SmokeyBacon says:

    So it sounds like even if he had never been a smoker his rate would be higher from the Welbutrin, since he was told that any anti-depressant would result in the same rate hike. So I don’t get it – was the initial reason REALLY smoking or was it that he takes an anti-depressant? Did they just say smoking because it was a quick, easy response and they are just dumb, or what? I don’t get it – it all just sounds fishy.

    • Nigerian prince looking for business partner says:

      I’m guessing smoking was the primary reason for the rate adjustment and even if he can convince Anthem he didn’t smoke, he’d still wind up with a rate hike or rejection for being on anti-depressants. Whether he’s smoking or is depressed, he’s still going to be classified as sub-prime by the underwriters.

  19. sprybuzzard says:

    Man, screw these freaking insurance companies. I was told that in order for my company to pay for a certain medication, I had to take two other medications first. I already had, two years prior, and neither worked well. Because I didn’t take them back to back, they wanted me to take them again before approving the third medication. My doctor had to call them and straiten everything out before they would pay for it, after my copay. For the record, that medication finally worked for me. They sit in some office hundreds or thousands of miles from ever seeing or knowing you, yet they make these decisions contradicting a doctor who has.

    • Nigerian prince looking for business partner says:

      In a way, that’s one of the nice things about having a HDHP vs. a PPO. You pay for pretty much everything out-of-pocket but pay significantly lower premiums in the process.

      I have a friend who was complaining that his insurer wouldn’t pay to remove a particularly nasty mole from his face because it was considered cosmetic. If the thing was on my face I would just pay for the procedure out-of-pocket from my HSA, regardless of whether my insurer considered it cosmetic or not. Either way, the total cost would be below my deductible anyways. The $8,000/year I’m saving in premiums goes a long way towards paying for medical care.

    • Dr. Shrinker says:

      Not to mention the person making that complicated medical decision often isn’t even a physician.

  20. gitmo234 says:

    If I read this correctly he stopped smoking in 2007 and is still taking wellbutrin? For smoking cessation its normally prescribed for 30 or 60 days. Mine was a thirty day dose and by the end of week 1 I had lost the desire to smoke and just stopped, without withdrawals. I just remember taking it to stop smoking and it felt like I could suddenly focus hard enough on a test to see the answers, etc. Had all the claimed anti-ADHD, and anti-depression effects but I

    If he’s still taking it, it sounds more like the clinical anti-depression use. was able to just stop smoking. If you buy it as a name brand, Zyban, it comes with a “power pack” or something like that, which is a thirty day supply. Otherwise you can get Zyban (or its generic, wellbutrin) in long term doses for anti-depression.

    Funny, because my BCBS insurance covered the generic 100%, no copay, to stop smoking.

    • gitmo234 says:

      Weird jumping around with my sentences there. One sentence has half of it in the first paragraph and the other half in the second

  21. Patriot says:

    The generic name of the medication under discussion is bupropion. My understanding is that Wellbutrin is the brand name utilized for treating depression. Zyban is the brand prescribed for smoking cessation. Now if you were prescribed the generic, you’re out of luck. However, if you’re prescribed the brand name Wellbutrin, you have a right to an appeal as that brand is not prescribed for smoking cessation.

    • witeowl says:

      I say the doctor’s notes should come into play. What was the reason for prescribing it initially, and what is the reason for prescribing it now? My prescriptions are all written with the generic name (except when there is no generic available). I’d hate to be told four years from now that I’ve been taking something to stop smoking when I’ve never smoked in the first place.

  22. Robert Nagel says:

    I’m surprised they issued the policy with depression on the list of health conditions your husband has. You got off lucky. They may be using the tobacco ruse as a way to evade some governmental regulation forbidding them to use depression as a disqualifying condition.

  23. NotLeftist says:

    Execute some insurance company executives. Do it by feeding them, alive, to dogs–in front of their families. Then ask them if antidepressants are tobacco products. Keep repeating until we finally get a correct answer.