What to do if insurance denies treatment based on your weight

you go doctor for the medicine or procedure necessary for a happy, healthy life. Your doctor approves … but your insurance doesn’t.

This happens frequently. Near New York Times article, for example, patients who qualify for a new weight-loss drug are denied coverage by their health care company. Insurers say these treatments are just futility, meaning people should try to lose weight on their own; Doctors say the drug could save lives for obese patients struggling with weight.

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

This specific dilemma occurs for people who are overweight or obese and seek other types of treatment: IVF, breast reduction, joint replacement, organ transplants. Some doctors may require medication for these issues, which may be “too dangerous” to try if you’re at a certain weight. Others may have problems with insurance agencies saying that treatment is “unnecessary” unless you are trying to lose weight on your own.

But losing weight is not that easy. So many factors play a role in weight — genetics, medications, where you live, culture, and more. In fact, even if we all ate and exercised the same way, we would see different numbers on the scale. Veight does not automatically determine whether someone is healthy.

Plus, weight loss efforts can be triggering (and dangerous) for some people. research shows Diet is the most important predictor of an eating disorderthe and Eating disorders are the second leading cause of mental illness.

But telling the insurance company all this? It’s tiring – and, unfortunately, not effective. What can you do if you want to treat a problem but your weight won’t cover it? And how can you handle all this emotionally? Here are some tips:

Find the right doctor

Some doctors are more passionate (and experienced) in tackling weight stigma. Tori Stroker’s nutrition blog has several resources This will help you find one in your area.

“My first recommendation is to find a doctor (or other health care provider) who can cover you with your insurance company,” he said. Christine Byrnean Anti-diet nutritionist and journalist. “They speak the language of insurance better than the average consumer, so they can work more effectively for your coverage.”

He said they can explain that declining coverage could lead to more expensive medical care down the road, for example. Doctors can also submission of documentsAs such lab results, notes on how you responded to other treatments, clinical guidelines for treatment, and more.

Appeal a denial of coverage

You have the right to appeal your insurance decision (Within 180 days). If you go this way, call the insurance company’s member services representative and be prepared to share your insurance information, what your insurance denied, why, and what’s next. Pay attention to when you do this and what is said.

“This could include writing a note to doctors, doing medical research to support the decision, writing a personal complaint,” he said. Ragen ChastainBar obesity activist, researcher and writer newsletter the and seminars on topics such as weight stigma. If that doesn’t work, you can contact a lawyer, he said.

The process may take some time, but persistence is key. It may (finally) be covered for you.

“Each organization has specific required documentation, but the general rule is that more information is better,” added Dr. Maggie Lands, an anti-diet doctor who experienced weight stigma in personal health care. It also offers a letter with peer-reviewed references that support positive results. “Is it magic? Horse. But I believe that every opportunity to make a small crack in this system of discrimination is worth the effort,” said Landes.

Consider other payment options

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

  • Pharmacy coupons: See if your doctor can give you a GoodRx card. alternatively, other coupons available through Novo Nordisk, Eli Lilly, Sanofi and Xeris.
  • Healthcare Credit Cards: CareCredit A credit card you can use for out-of-pocket health expenses.
  • Payment plans: Ask your doctor or the front office payment plans (some of which are interest free).

KrizzDaPaul via Getty Images

Weight does not always cause health problems and you deserve the right treatment.

How to fight weight stigma in health care

Everyone deserves respect regardless of weight. Unfortunately, some people just don’t get it – and it’s okay if you disagree. “If you’re denied medical care because of your weight, you have every right to feel angry, upset, whatever,” Byrne said. “It’s inhumane.”

Although weight discrimination is something you shouldn’t have to face, it’s a painful reality in our society. The following will help you cope:

Find a therapist (or someone else) who gets it

“Find a therapist who specializes in body image or weight stigma the and “Living in a larger body can be incredibly healing,” Byrne said. “That’s not to say thin providers can’t be educated about weight stigma, but many people feel they can talk to a professional who has experience and expertise on the topic.”

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

If you can’t access therapy due to cost, location, or other reasons, it can also be helpful to find someone else who understands—an Instagram professional, a friend. Search for words like “fat loss,” “anti-diet,” and “HAES” to find people to follow on social media.

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

– Christine Byrne

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

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

“Know this first you are It’s not broken,” Landes said. “The system is so broken, and unfortunately, you’ve been a victim of weight stigma and personal discrimination for decades, which has become the way our system cares for patients.”

The health care system relegates people to larger organs and then blames them for it. “This health care system can blame and punish overweight people by not providing research, tools, best practices and pharmaceuticals that target thin bodies,” Chastain said.

Landes shared that the usual argument is that larger patients are riskier to operate on, but high-risk patients are always operated on.

“Essentially everyone is a combination of risk factors, so we work on an informed consent model,” he said. “We do it every day, but somehow fat people are excluded from that choice. … It’s appalling that we continue to do this, and frankly, I think it’s negligent and possibly criminal at best not to give them a choice in an informed consent model.”

Fat people are suffering because of lack of health care. “If someone believes that an obese person’s surgical outcome, say a total knee replacement, is not going to be as good as a thin person’s, that doesn’t justify letting obese people suffer without any relief,” Chastain added.

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

“To be clear, you don’t have to fight for the standard of medical treatment just because of your size, but until the culture of health care changes (which many prominent advocates are trying to do) to protect your humanity in a system that continues to ignore harm,” Landes said. i am sorry.”


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