laboratory testing

blood draw

We all know the routine. The examiner draws blood during a mobile exam. Delays in processing allow those hungry red blood cells to gobble up glucose. The underwriter sees an extremely low glucose reading or the dreaded not valid glucose (NVG) on the laboratory report. Or the laboratory report notes hemolysis is present. Then there are the results of a CBC where the blood was collected Friday afternoon, but not analyzed until Monday morning.

Now what? Does any of this matter to the underwriter?

What changes?

We used to think glycolysis was a seasonal issue. While it is more severe during the warm summer months, ExamOne data shows this issue is present throughout the year. But the question is: does very low glucose or not valid glucose still matter to life insurers?

With the majority of insurers now routinely testing A1c on every blood specimen, concerns with glycolysis are almost eliminated. A1c measures average blood glucose level for the preceding two to three months and is unaffected by glycolysis. Thus, it is a superior underwriting tool for measuring glucose control and is the recommended testing protocol for diagnosing diabetes by the American Diabetes Association.

Companies foregoing A1c testing must order a blood collection recheck or roll the dice and hope the applicant does not have a risk of glucose intolerance or diabetes.

What about hemolysis?

Hemolysis is the breakdown or rupturing of red blood cells. Hemolysis has a minor effect on a few blood analytes—particularly the aspartate aminotransferase (AST)—and is generally of minimal concern to the underwriter. Underwriters can feel comfortable underwriting specimens reported as having slight hemolysis.

Severe hemolysis, however, may have a significant effect on the AST, alanine transaminase (ALT), alkaline phosphatase (ALP), bilirubin, protein, triglyceride and glucose. If the hemolysis is too severe, the laboratory may result those analytes as “not valid – hemolysis” (NVH). Basing underwriting decisions on severely hemolyzed specimens can be risky.

Hemolysis and specimen processing delays can affect complete blood count (CBC) results by falsely decreasing or elevating a number of components in the CBC. Prompt processing of the CBC is critical, especially in cases where the underwriter orders the CBC “for cause.”

CBC results are fairly stable for approximately 72 hours at room temperature. Refrigerated specimens are stable even longer—for another two days. Delays in processing yield questionably accurate results, especially when evaluating anemic applicants.

Two options for reducing or eliminating glycolysis and hemolysis

According to ExamOne data, 15 percent of specimens are impacted by glycolysis and 4 percent are impacted by hemolysis. Advancements in testing protocol and availability of clinical exam centers have helped reduce the prevalence of specimen degradation.

specimen quality

A1c is stable for the life of the purple top tube—28 days—and it is unaffected by pre-analytic conditions such as heat and time, eliminating the risk of glycolysis. ExamOne’s routine risk assessment screen includes A1c testing so every specimen is tested upon arrival at the laboratory.

In addition to being a convenient option for applicants, exam centers provide a level of confidence unmatched in the life insurance industry. ExamOne data shows NVG rates of specimens drawn at exam centers are less than 0.1 percent, while NVH rates are less than 0.5 percent. Blood collected at an ExamOne or Quest Diagnostics exam center is processed and analyzed within 48 hours so the chances of specimen degradation due to temperature or processing delays are significantly reduced, giving insurers confidence they are basing underwriting decisions on accurate health insights.

Take action on World Hepatitis Day

by ExamOne on July 27, 2018

Each summer, the World Health Organization commemorates World Hepatitis Day on July 28 to spread awareness and understanding of the disease and its impact. Hepatitis is one of the world’s leading causes of death with 1.34 millions deaths a year. Currently, more than 300 million people are living with the disease. That is why it is important for the world to join together and take action to eliminate hepatitis.

Resources and educational information for individuals

According to the CDC, approximately 75% of people living with hepatitis are not aware or do not have symptoms of an infection. That includes 3 million baby boomers who are infected with the hepatitis C virus. Without knowledge of the infection, it could develop into fatal liver disease. Knowing your status is the first step. Quest Diagnostics provides resources such as test reminders, educational videos, and information on blood tests that can help determine status.

Hepatitis testing for life insurance

The CDC has found infections are increasing rapidly among young people because of the rise in opioid misuse. That, in addition to the prevalence of hepatitis C among baby boomers, is why it is important for life insurers to consider hepatitis screening for applicants of all ages. ExamOne offers a screening for the antibody of viral liver disease. Presence of the antibody indicates the presence of either a current or past hepatitis C infection. Learn more about ExamOne’s hepatitis C screening for life insurance companies.

Determine risk and raise awareness

The good news is that events like World Hepatitis Day bring more awareness to the issues and help more people become aware of their risk and screening options. Quest Diagnostics offers a short quiz to help individuals determine their risk of hepatitis C. In addition, ExamOne’s Strategic Account Representatives can help life insurance clients evaluate options for hepatitis C testing for individuals applying for life insurance.

The rise in workforce drug positivity may be a concern among the life insurance population

June 22, 2018 Carriers

2018 Quest Diagnostics Drug Testing Index™ The 2018 Quest Diagnostics Drug Testing Index™ (DTI) has been released and workforce drug positivity remained at the highest rate we’ve seen in a decade. The positivity rate held steady at 4.2 percent which was the same in 2016. One of the biggest shifts in drug positivity was seen […]

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Insights that help insurers improve precision underwriting in the life insurance market

May 31, 2018 Carriers

At the recent Association of Home Office Underwriters (AHOU) meeting, Executive Vice President, Betsy Sears, shared insight that our data analytics team has collected and analyzed comparing self-disclosure to positive confirmations of various laboratory tests. Our insurance clients tell us consistently that fraud is a top concern – whether intentional or unintentional applicant nondisclosure, it […]

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Debunking the myths: the facts about cotinine

September 21, 2017 Carriers

According to the Foundation for a Smokefree America, smoking is the single most preventable cause of death and disease causing more fatalities than cocaine, auto accidents, AIDS, alcohol, heroin, fire, suicide and homicide combined. The relationship between nicotine and cotinine Cigarettes are made up of tar, carbon monoxide, acetaldehyde, nitrosamines, nicotine and 4,000 different carcinogenic […]

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How much does life insurance cost a Millennial?

August 23, 2017 Applicants

I recently shared something very private in a very public forum. It may even be something you do, too. No, it wasn’t a deep dark secret – it was my monthly subscription spending! Yes, I’m that person. I have gym memberships, product deliveries, online movie service and several other monthly fees that totaled more than […]

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Webinar: Millennial behavior and laboratory insights

August 11, 2017 Carriers

Did you know there are 1.8 billion Millennials worldwide? Their purchasing behavior has redefined how businesses position their messaging, products and services. According to the 2016 Insurance Barometer study, 43% of millennial households own individual life insurance. So what do insurers and producers need to know when targeting millennials? And what trends are we seeing […]

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Illicit drug use in the US is at the highest rate in a decade

June 26, 2017 Carriers

Quest Diagnostics released its annual Drug Testing IndexTM in May.(1,2)  It revealed that the American workforce had the highest positivity rate for illicit drugs in the past 12 years. Cocaine continued its upward trend for the fourth consecutive year. Marijuana positivity increased dramatically with notable increases in Colorado and Washington, both states that have legalized […]

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How life insurers can support men’s health with actionable insights

June 5, 2017 Carriers

This June, we’re committed to raising awareness about men’s health. Insurers have a unique opportunity to support applicant health because of the health discovery process during a life insurance application. Prevalence of chronic diseases, like heart disease and diabetes, continues to grow in the United States. In 2015, 191 million Americans had at least one […]

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Committed to getting results

April 24, 2017 Carriers

Some of our ExamOne everyday heroes can be found working in our laboratories. From prepping specimens, to testing and analyzing results, these employees play a vital role in the critical testing we perform—ultimately helping more families be protected with life insurance. Medical Laboratory Professionals Week (MLPW)—celebrated April 23-29 this year—is a special opportunity to recognize […]

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