What to do if your insurance denies you treatment based on your weight

You go to the doctor for the medication or procedure you need to live a happier, healthier life. Your doctor approves…but your insurance doesn’t.

This happens often. Recently New York Times article, for example, highlighted how patients eligible for a new weight-loss drug were denied coverage by their health care company. Insurers claim the treatment is vanity, which essentially means people should try to lose weight on their own; doctors said the drug could be a lifesaver for their obese patients struggling with their weight.

By law, insurance companies can get away with these types of weight-based assessments. Weight discrimination is legal in 49 states – all but Michigan.

This particular dilemma arises for overweight or obese people who also seek other types of treatment: IVF, breast reduction, joint replacement, organ transplants, whatever. Some doctors may argue that the drug for these problems it may be “too risky” to try if you are a certain weight. Others may run into problems with their insurance agency, which may claim that treatment is “unnecessary” if you haven’t tried to lose weight on your own first.

But losing weight is not so easy. So many factors play into weight — genetics, medications, where you live, your cultural background and more — meaning it’s not just an “eat less and move more” situation. In fact, even if we all eat and exercise the same way, we will still see different numbers on the scale. Ueight does not automatically determine if someone is healthy.

Also, trying to lose weight can be triggering (and even dangerous) for some people. A study shows diet is the most important predictor of an eating disorderand eating disorders are the second deadliest mental illness.

But telling your insurance company all this? It’s exhausting — and maybe not even effective, unfortunately. So what can you do if you want treatment for a certain problem but it won’t be covered because of your weight? And how can you deal with the emotional toll of it all? Here are some tips:

Find the right doctor

Some doctors are more passionate (and experienced) in dealing with weight stigma. Tori Stroker’s Nutrition Blog has several resources which can help you find one in your area.

“My number one recommendation would be to find a doctor (or other health care provider) to advocate for you with insurance companies,” said Christine Byrnean anti-diet nutritionist and journalist. “They speak the language of insurance better than the average consumer, so they may be able to make a more effective case for your coverage.”

She said they can explain how denying coverage for it could lead to more expensive medical care in the future, for example. Doctors can too provide documentationlike lab results, notes about how you responded to other treatments, clinical guidelines for treatment, etc.

Appeal your insurance denial

You have the right to appeal the decision of your insurance (within 180 days). If you go this route, call a member services representative at the insurance company and be prepared to share your insurance information, what your insurance denied, why, and any follow-up details. Note when you do this and what it says.

“It may involve doctors writing a note, gathering medical research to support the decision, writing a personal statement,” said Reagan Chastainfat activist, researcher and writer who has newsletter and workshops on topics such as weight stigma. If that doesn’t work, she said, you can hire a lawyer.

The process may take some time, but persistence is key. It can (possibly) get you covered.

“Each organization has specific required documents, but the general rule is that more information is better,” added Dr. Maggie Landes, an anti-diet doctor who has personally experienced weight stigma in health care. She also recommends a letter of peer-reviewed references that supports positive results. “Is this magic? No. But I believe that any opportunity to make a small dent in this system of discrimination is worth the effort,” Landes said.

Explore other payment options

If you have to pay for the drug or procedure without insurance, know that there are resources that can make it more affordable, such as:

  • Pharmacy Coupons: See if your doctor can give you a GoodRx card. Alternatively, other coupons are available through Novo Nordisk, Eli Lilly, Sanofi and Xeris.
  • Healthcare Credit Cards: CareCredit is a credit card you can use for out-of-pocket health-related expenses.
  • Payment plans: Ask your doctor or the front desk payment plans (some of which do not charge interest).

KrizzDaPaul via Getty Images

Weight is not always the cause of health problems and you deserve proper treatment.

How to tackle weight stigma in health care

Everyone deserves respect regardless of their weight. Unfortunately, some people don’t recognize this – and it’s best not to fall for it. “If you’ve been denied medical care because of your weight, you have every right to be angry, upset, whatever else you feel,” Byrne said. “It’s inhumane.”

While weight discrimination is something you shouldn’t have to deal with, it is a disgusting reality in our society. The following may help you cope:

Find a therapist (or other person) who gets it

“I’m looking for a therapist who specializes in body image or weight stigma and the lives themselves in a larger body can be incredibly healing,” Byrne said. “That’s not to say that thinner providers can’t be made aware of weight stigma, but many people find that being able to talk to a professional who has both experience and lived experience of the topic is more helpful.”

Psychology Today has a database of therapists you can filter and The Health at Every Size website will have the list by this fall.

If you can’t access therapy because of cost, location, or another reason, finding someone else who understands—an Instagram pro, a friend—can also be helpful. To find people to follow on social media, search for words like “fat loss,” “anti-diet,” and “HAES.”

“If you’ve been denied medical care because of your weight, you have every right to be angry, upset, and whatever else you feel. This is inhumane.”

– Christine Byrne

Remind yourself that you are not the problem and you deserve better

When your insurance company basically blames you for the health challenges you’re experiencing, it’s easy to believe that it’s your fault or that you need to change—but you don’t.

“First and foremost, know this you they’re not broken,” Landes said. “The system is very, very broken, and unfortunately you are a victim of decades of weight stigma and personal discrimination that are woven into the way our system cares for patients.”

The health care system fails people in larger bodies, then blames them for it. “It can incriminate and penalize people who are heavier, where the health care system fails to accommodate them with research, tools, best practices and pharmaceuticals that are focused on thin bodies,” Chastain said.

Landes said the usual argument is that it’s riskier to operate on larger patients, but high-risk patients are operated on all the time.

“Essentially, every person is a mixed set of risk factors, so we operate in an informed consent model,” she said. “We do it every day, but for some reason fat people are excluded from even being able to make that choice. … It’s appalling that we continue to do this, and frankly, I think it’s negligent at best and possibly criminal to not allow them a choice in an informed consent model.”

Fat people suffer because of a lack of respect for health care. “If someone believes that the outcome of a fat person’s surgery for, say, a total knee replacement won’t be as good as that of a thin person, that doesn’t justify letting fat people suffer without any relief,” Chastain added.

You deserve better, even if doctors or insurers don’t treat you this way.

“To be clear, you don’t have to fight for the standard of treatment just because of your size, but until the culture of health care changes (which many extraordinary advocates are trying to do), you may be forced to defend your humanity in a system that that continues to ignore the harm caused,” Landes said. “And I’m sorry for that.”

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