What to do if your insurance denies you treatment because of your weight

You are going to the doctor for a medication or procedure you need to live a happier, healthier life. Your doctor approves… but your insurance does not.

This happens frequently. A recent New York Times article, for example, highlighted how patients who qualified for a new weight-loss drug were denied coverage by their healthcare company. Insurers claimed the treatment was just for vanity, essentially implying that people should try to lose weight on their own; doctors said the drug could save the lives of their obese patients struggling with their weight.

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

This specific dilemma arises for overweight or obese people who also seek other types of treatment: IVF, breast reductions, joint replacements, organ transplants, etc. Some doctors may claim that medication for these problems may be “too risky” to try if you are over a certain weight. Others might run into trouble with their insurance agency, which might claim the treatment is “useless” if you haven’t tried to lose weight on your own first.

But losing weight is not that easy. So many factors play a role in weight — genetics, medications, where you live, your cultural background and more — which means it’s not just an ‘eat less and move more’ situation. In reality, even if we all ate and did the same thing, we would still see different numbers on the scale. Oeight does not automatically determine if someone is healthy.

Additionally, attempts to lose weight can be triggering (and even dangerous) for some people. Studies show dieting is the strongest predictor of an eating disorderand eating disorders are the second deadliest mental illness.

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

Find the right doctor

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

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

She said they could explain how denying coverage for it could lead to more expensive medical care down the road, for example. Doctors can also provide documentssuch as lab results, notes on how you responded to other treatments, clinical guidelines for treatment and more.

Appeal your insurance denial

You have the right to appeal the decision of your insurance (within 180 days). If you follow this road, call an insurance company member services representative and be prepared to share your insurance information, what your insurance declined, why, and any follow-up details. Note when you do it and what is said.

“This may involve asking doctors to write a note, compiling medical research to support the decision, writing a personal statement,” said Ragen Chastaina strong activist, researcher and writer who has a newsletter and workshops on topics like weight stigma. If that doesn’t work, she says, you can hire a lawyer.

The process may take some time, but perseverance is key. This could (eventually) get you some coverage.

“Each organization has specific documents required, 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 with peer-reviewed references that support positive results. “Is it magic? No. But I believe every opportunity to make a small crack in this system of discrimination is worth it,” Landes said.

Find other payment options

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

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

KrizDaPaul via Getty Images

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

How to deal with weight stigma in healthcare

Everyone deserves respect, regardless of weight. Unfortunately, some people don’t recognize that – and it’s okay to disagree with that. “If you’ve been denied medical attention because of your weight, you have every right to be angry, upset and whatever you feel,” Byrne said. “It’s inhumane.”

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

Look for a therapist (or other person) who gets it

“Seek a therapist who specializes in body image or weight stigma and larger body lives themselves can be incredibly healing,” Byrne said. “That’s not to say that thinner providers can’t be educated about weight stigma, but many people think it’s more helpful to be able to talk to a professional who has both expertise and experience. lived on the subject.”

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

If you can’t access therapy due to cost, location, or some other reason, finding someone else who understands — a professional on Instagram, a friend — can also be beneficial. To find people to follow on social media, search for terms such as “fat release,” “anti-diet,” and “HAES.”

“If you’ve been denied medical attention because of your weight, you have every right to be angry, upset and feel whatever you’re feeling. It’s inhumane.

-Christine Byrne

Remember you are not the problem and you deserve better

When your insurance company essentially blames you for the health issues you’re having, it’s easy to believe you’re at fault or need to change, but you’re not.

“First of all, know that you are not broken,” Landes said. “The system is very, very flawed, and unfortunately you are the victim of decades of weight stigma and personal discrimination that is embedded in the way our system cares for patients.”

The healthcare system drops people into bigger bodies and then blames them for it. “It can blame and punish people with high weights where the healthcare system fails to accommodate them with research, tools, best practices and pharmaceuticals focused on lean bodies,” Chastain said.

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

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

Fat people suffer because of a lack of respect in health care. “If anyone thinks that a fat person’s surgical results for, say, a total knee replacement, won’t be as good as a thin person’s, that doesn’t justify letting fat people suffer without any relief,” Chastain said. added.

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

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

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