Patient advocates are crying foul over a first-of-its-kind coverage policy instituted by Blue Cross and Blue Shield of Tennesseeone that requires seriously obese members to undergo intelligence testing before being approved for bariatric surgery.
The Obesity Action Coalition has called for the Tennessee Blues to immediately scrap the test, part of a rigorous medical and psychological screening process prior to the procedure. The coalition claims that the policy, implemented by the Chattanooga-based company in April 2006, is discriminatory and sets a dangerous precedent of denying access to care based on a patients intellect.
Theyre perpetuating the ugliest of stereotypes associated with obesity todaythat the obese are somehow of lower intelligence than the general public, says coalition spokesman James Zervios. Its just another hurdle for the obese patient to overcome in trying to access life-saving treatment.
By its own account, the Tennessee Blues is the first known insurer to require IQ testing to access any medical procedure, bariatric or otherwise. But the 4.6 million-member company insists it has never denied coverage based on a patients IQ score; rather, the test results are used to ensure that patients are mentally equipped to undergo a major procedure that will require them to make lifelong changes in diet and exercise.
There is nothing in our policy that indicates you cannot have the procedure if you score below a certain level, says Tennessee Blues spokesman Mary Thompson. But based on what a persons score is, we know how much follow-up they will need or how intensive the case management should be. If a persons IQ is deemed low it could have a bearing on the level or method of (preoperative education) and follow-up they require.
The new policy comes as health insurers, deluged by bariatric-surgery claims, have been moving to restrict coverage of the $25,000 procedure. Some insurers have stopped paying for the surgery altogether, while a growing number of others now require patients to either lose 10% of their body weight or prove they failed a medically supervised diet program.
Zervios fears that the Tennessee Blues new policy could create a snowball effect among insurers desperate to cut costs. This is something that needs to be stopped before it catches on anywhere else, he says. Otherwise, whats next? Denying cancer patients chemotherapy if their IQ scores come back too low?