A new way to deny coverage
We’ve talked before about bariatric surgeries (procedures for obese patients to lose weight) and the difficulties as well as the cost. Patient advocates are now upset because of a new kind of coverage policy instituted by Blue Cross and Blue Shield of Tennessee. This new original policy requires seriously obese members to undergo intelligence testing before being approved for bariatric surgery.
The test involves a fairly extensive medical and psychological evaluation prior to the procedure and the Obesity Action Coalition has asked for it to be stopped immediately.
The coalition believes the policy is discriminatory and sets a dangerous precedent of denying access to care based on a patient’s intellect.
The quote out of Modern Healthcare was “They’re perpetuating the ugliest of stereotypes associated with obesity today—that the obese are somehow of lower intelligence than the general public,” says coalition spokesman James Zervios. “It’s just another hurdle for the obese patient to overcome in trying to access life-saving treatment.”
This is the first time we have heard of an insurance company requiring this type of testing for any medical procedure although I know there are less rigorous psychological tests done before transplant surgeries. Whether this is required by the insurance company or just the “Standard of Care” is unknown.
This insurance company states it has never denied coverage based on a patient’s IQ score and the testing is to help ensure that patients are “mentally equipped” to undergo the procedure.
Typical Bariatric procedures cause a major lifestyle changes and adjustments and poor adjustment to the changes can hinder the success of the procedure as well as increase the morbidity.
Lower scores could help the physician and healthcare workers to decide which patients may need closer follow-up and more intensive interventions.
As reported in an earlier blog, many of these procedures are not covered by insurance and if the ~$25,000 procedure were offered to everyone, companies may not be able to afford to provide insurance for their employees.
Many patient advocates are concerned that this policy will set a standard that will be used later to deny other benefits.
The test involves a fairly extensive medical and psychological evaluation prior to the procedure and the Obesity Action Coalition has asked for it to be stopped immediately.
The coalition believes the policy is discriminatory and sets a dangerous precedent of denying access to care based on a patient’s intellect.
The quote out of Modern Healthcare was “They’re perpetuating the ugliest of stereotypes associated with obesity today—that the obese are somehow of lower intelligence than the general public,” says coalition spokesman James Zervios. “It’s just another hurdle for the obese patient to overcome in trying to access life-saving treatment.”
This is the first time we have heard of an insurance company requiring this type of testing for any medical procedure although I know there are less rigorous psychological tests done before transplant surgeries. Whether this is required by the insurance company or just the “Standard of Care” is unknown.
This insurance company states it has never denied coverage based on a patient’s IQ score and the testing is to help ensure that patients are “mentally equipped” to undergo the procedure.
Typical Bariatric procedures cause a major lifestyle changes and adjustments and poor adjustment to the changes can hinder the success of the procedure as well as increase the morbidity.
Lower scores could help the physician and healthcare workers to decide which patients may need closer follow-up and more intensive interventions.
As reported in an earlier blog, many of these procedures are not covered by insurance and if the ~$25,000 procedure were offered to everyone, companies may not be able to afford to provide insurance for their employees.
Many patient advocates are concerned that this policy will set a standard that will be used later to deny other benefits.
posted by Anonymous at 5:53 AM
4 Comments:
I've never claimed to be a physician (that whole "science" part of medical school was just too much - ha). But, I do know that the bariatric surgeries that HB is discussing are really very dangerous procedures, and require a very significant amount of post-operative compliance and commitment to lifestyle change.
I think too many people see these "Biggest Loser" shows or know someone who has successfully undergone the surgery and dropped several hundred pounds, and think that the surgery is all that is required. However, as I understand it, the surgery also requires a significant lifetime commitment to be compliant with the post-surgical life restrictions that such a surgery entails.
That being said, I think the healthcare professionals involved in the procedures should have the foremost duty and responsibility to ensure that the patients who are considering these drastic surgeries are FULLY understanding of what they entail, the HUGE risks of the procedure, and the life changes which will follow. Its more than simply getting the surgery and eating less afterwards. However, to the extent that insurers are requiring IQ tests and whatnot, I think that is APPALLING. If the health professionals at issue think their patient is a good candidate for all the neccessary medical reasons, and they have ensured the patient is informed and understanding of what will follow, the insurers need to stay out of the intelligence testing business.
By the way, did you notice the story in the Courier-Journal today that Humana "more than doubled its earnings in its 2006 profit to nearly $155 million last year (from "only" $61.8 million a year earlier). Anyone who wonders where their insurance premiums are going should buy Humana stock to at least get a dividend share of their premiums in return....
I think that most physicians can tell if a person is intelligent without an IQ test. I don’t think many people can fake intelligence.
I have noticed that the people who are obese because of anxiety, stress, etc. are replacing one bad addiction for another. They may have weight loss after the surgery, but will most likely pick up another addiction like drugs, sex with multiple partners, alcohol, etc. Obviously these addictions can cause as many medical problems as obesity if not more. The people who are addicted to food because of a problem in their life need to fix that first and then consider the surgery.
I agree with lawguy about the "biggest loser" theory.
And, being in health care, I work daily with paitents that don't understand basic concepts of infection control or even the names of the medications they take or what they are for. how are they supposed to understand the complexities of such a drastic surgery? yet denying them the right to have the surgery based on their intelegence is wrong. extensive follow up is the only answer.
This has more to do with "emotional intelligence" than the kind of intelligence we refer to in a social context. It's not a question of only allowing smart people to have the surgery...did you people even read the whole article?
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