Published January 29, 2007
When a 330-pound Pam Davis underwent gastric bypass surgery five years ago, her main concern was to save her own life so she could be there for her children.
Nowhere along the line did a doctor or an insurance company question whether she had the "intelligence" necessary to make the decision about having the surgery to help her lose weight and reclaim her health.
Now, BlueCross BlueShield of Tennessee is requiring patients prove just that.
In April 2006, the company introduced a controversial new stipulation, requiring IQ screening for all morbidly obese patients looking to undergo gastric bypass surgery.
According to a 2006 report by Trust for America's Health, Tennessee was ranked the nation's sixth heaviest state, with adult obesity rates of 26.6 percent.
During the potentially life-saving procedure, doctors staple part of the patient's stomach, which reduces the amount of food eaten, often leading to drastic weight loss.
Recent years have seen growing numbers of patients requesting the procedure, putting an additional burden on these organizations.
"The term IQ test is misleading," Mary Thompson, spokeswoman for BlueCross Blue Shield of Tennessee, told FOXNews.com. "It really measures the patient's knowledge of the surgery itself and the eating and lifestyle changes necessary afterward."
BlueCross's own documentation, however, spells out strict guidelines for patients considering the procedure that includes the need for both an IQ screening approved by the American Psychological Association, and additional tests designed, as Thompson indicates, to measure eating behavior or attitudes, along with other evaluative materials from a psychologist or psychiatrist.
Thompson, however, said no patients have been turned down for surgery to date based solely on their IQ score.
Obesity advocates — and former gastric-bypass patient Pam Davis — say the policy is just plain wrong.
"One of the thoughts along this avenue is that obesity is seen as one of the last socially acceptable forms of discrimination," said Davis, a registered nurse and gastric bypass success story who lost 160 pounds after her surgery.
Obesity Action Coalition, a nonprofit group that works to educate people about the realities of obesity, stepped up immediately to speak out against the policy.
"This is blatant discrimination against those affected by obesity who are trying to access care," said James Zervios, director of communications for the coalition. "For people going through the process now it's yet another hurdle to jump to access treatment."
Susan Estrich, FOXNews' legal analyst and professor of law and political science at the University of Southern California thinks the insurance company should be ashamed of themselves.
"Imagine if we did this to people who smoked, ride motorcycles, or take other risks which you and I might consider foolish, and then get sick and need help," said Estrich. "Shall we test everyone to determine the extent to which they are 'responsible”' for their condition or deserving of treatment?"
"Morbid obesity is an illness, not a sign of reduced intelligence that has to be rebutted in order to qualify for treatment."
The coalition first learned of the policy when a Tennessee BlueCross patient who was seeking treatment came to them with concerns about the new stipulation.
"This requirement was erroneously thrown in," Zervios said. "They haven't published evidence saying if it works, it's just been tossed into the policy. Where did it come from?"
Rick Mayes, assistant professor of public policy at the University of Richmond, and a nationally recognized expert on health insurance, said it's unheard of for insurance companies to require IQ tests.
"I have never heard of this before," said Mayes, referring to the Tennessee BlueCross IQ requirement.
But, he added, it's not surprising considering the rising rates of obesity and the growing prevalence of the surgery.
"It’s a double whammy for these companies. As the procedure becomes more available and more people become eligible, they're getting scared," he said.
Businesses are always looking to keep costs down, and insurance arrangements are essentially business contracts, Mayes added.
"This is symptomatic of insurance companies trying to avoid costly patients."
As a nurse, Davis said she weighed the decision to undergo gastric bypass surgery thoughtfully with a wealth of information. The same is true, she says, for most patients looking to undergo the procedure.
Before her surgery, Davis worked as a nurse in a vascular center, but after her experience, she was inspired to work with others going through the bariatric [weight-loss] surgery process.
"When patients first come to a seminar on the surgery, they tend to very educated already, we just reinforce that education," she said. "And we insure that they're prepared."
Psychological evaluation is already a required and welcome part of the criteria for patients who are seeking the surgery, Davis contends, so the additional IQ testing is unnecessary.
"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," she said.
Weighing the Options
BlueCross maintains that the new screening only determines how much additional attention the patient may need.
"To say that this policy is discriminatory is absolutely false," Thompson said. "Nothing in the policy indicates that if a patient's score is below a certain level they cannot have the procedure."
According to the company, the decision to enact the policy was made after the Tennessee BlueCross medical policy team attended the 2006 Bariatric Conference and learned that there was growing concern about patients' abilities to handle the procedure, as well as the follow-up care.
"If an IQ is deemed low, we'll work to ensure that the physician and medical team will follow the patient more closely during and after procedure, and they'll be more aware of the need to follow up with candidate," Thompson said.
How would Davis have felt if she had been asked to undergo such a test before her surgery?
"I would have been pretty outraged and indignant that a corporation is trying to decide if I'm smart enough to have a procedure that’s going to save my life," she said.
The OAC says their next step is to contact Tennessee state legislators about the issue, and ensure that lawmakers are aware of what's going on within their state.
With regards to the objections about their policy, Tennessee Blue Cross says they're open to the various points of view, but for now, the new requirement will stand.
"We're not developing policies in a vacuum. We take the feedback, process it, and look at the scientific evidence that exists," Thompson said. "For us, science wins out in terms of the safety of our members who look to us for health care."
But according to James Zervios and Pam Davis and others like them, the policy needs to be rescinded.
"We would never tell a cancer patient that they weren’t allowed chemotherapy until they had an IQ test," Zervios said. "The test is like a slap in the face for those that are trying to seek treatment."