Anger Erupts Over Insurance Company's IQ Test for Weight Loss Surgery
http://www.foxnews.com/story/0,2933,246519,00.html
Anger Erupts Over Insurance Company's IQ Test for
Weight-Loss Surgery
>>>>>>>>>snip<<<<<<<<<<<<
In a past life, I was on an insurance medical policy team. I suspect the article took the Tennessee BlueCross policy a little out of context. The current policy at http://www.bcbst.com/mpmanual/WHStart.htm doesn't have the words "IQ test" in it. As the policy reads now, it outlines those candidates that are most appropriate for bariatric surgery based on the available scientific evidence and consensus. Those without a concept of the personal changes it takes for bariatric surgery to be ultimately successful do not make good candidates.
I think insurance companies are trying to create policies that get away from creating comments like this: "I have to gain 10 more pounds before my insurance will let me have the surgery." Insurance companies have seen maverick surgeons and hospitals go willy-nilly with this surgery without much attention to appropriate screening, follow-up, or outcomes. Insurance companies have to cover the "train-wrecks" that can result from these surgeries, as well as the very common complications. It is not a cheap benefit.
A quote in the article:
"For complex procedures like heart transplants that
require elaborate medication regiments after surgery,
those patients don't have to undergo IQ tests to make
sure they're intelligent enough to follow instructions
afterwards..."
Maybe they would if they were screaming at the Insurance company to let them have heart surgery, or pounding down Big Macs with comments like, "I only need two more vessels to become 80% occluded before my Insurance will let me have the surgery."
If we're drawing analogies, why would transplant centers restrict candidates for liver transplants from those with alcohol or substance abuse problems? Isn't that discrimination?
Within the bariatric community, like many medical communities, there are those with strong and vocal convictions. This is not a bad thing, but there is the risk that things will get a little "extremist" (to use the FOXnews term) at times.
Nothing here excuses Insurance companies or insurance benefits from any of the way-out and ridiculous language and criteria that does exist.
N-
addtl info/resources on bariatric surgery:
http://www.facs.org/fellows_info/statements/st-34.html
http://www.facs.org/ahp/testimony/bariatric.html
http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf
http://www.obesityhelp.com/home/
Anger Erupts Over Insurance Company's IQ Test for
Weight-Loss Surgery
>>>>>>>>>snip<<<<<<<<<<<<
In a past life, I was on an insurance medical policy team. I suspect the article took the Tennessee BlueCross policy a little out of context. The current policy at http://www.bcbst.com/mpmanual/WHStart.htm doesn't have the words "IQ test" in it. As the policy reads now, it outlines those candidates that are most appropriate for bariatric surgery based on the available scientific evidence and consensus. Those without a concept of the personal changes it takes for bariatric surgery to be ultimately successful do not make good candidates.
I think insurance companies are trying to create policies that get away from creating comments like this: "I have to gain 10 more pounds before my insurance will let me have the surgery." Insurance companies have seen maverick surgeons and hospitals go willy-nilly with this surgery without much attention to appropriate screening, follow-up, or outcomes. Insurance companies have to cover the "train-wrecks" that can result from these surgeries, as well as the very common complications. It is not a cheap benefit.
A quote in the article:
"For complex procedures like heart transplants that
require elaborate medication regiments after surgery,
those patients don't have to undergo IQ tests to make
sure they're intelligent enough to follow instructions
afterwards..."
Maybe they would if they were screaming at the Insurance company to let them have heart surgery, or pounding down Big Macs with comments like, "I only need two more vessels to become 80% occluded before my Insurance will let me have the surgery."
If we're drawing analogies, why would transplant centers restrict candidates for liver transplants from those with alcohol or substance abuse problems? Isn't that discrimination?
Within the bariatric community, like many medical communities, there are those with strong and vocal convictions. This is not a bad thing, but there is the risk that things will get a little "extremist" (to use the FOXnews term) at times.
Nothing here excuses Insurance companies or insurance benefits from any of the way-out and ridiculous language and criteria that does exist.
N-
addtl info/resources on bariatric surgery:
http://www.facs.org/fellows_info/statements/st-34.html
http://www.facs.org/ahp/testimony/bariatric.html
http://www.asbs.org/html/pdf/2004_ASBS_Consensus_Conference_Statement.pdf
http://www.obesityhelp.com/home/
posted by nawledge at
10:22 PM
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