What To Do If Your Insurance Denies You Treatment Based On Your Weight

You go to the doctor for medication or a procedure you need in order 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 health care company. Insurers claimed the treatment was just for vanity, essentially implying people should try to lose weight on their own; physicians said the medicine could be lifesaving for their patients with obesity who struggle with their 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 pops up for people who are overweight or obese seeking other types of treatment as well: IVF, breast reductions, joint replacements, organ transplants, you name it. Some doctors may claim the medication for these issues may be “too risky” to try if you’re a certain weight. Others might run into issues with their insurance agency, which might claim treatment is “unnecessary” if you haven’t tried to lose weight on your own first.

But weight loss isn’t that easy. So many factors play a role in weight — genetics, medicines, 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 ate and exercised the same, we’d still see different numbers on the scale. Weight doesn’t automatically determine whether someone is healthy.

Plus, attempts at weight loss can be triggering (and even dangerous) for some people. Research shows dieting is the most important predictor of an eating disorder, and eating disorders are the second deadliest mental illness.

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

Some doctors are more passionate about (and experienced in) dealing with weight stigma. Tory Stroker’s nutrition blog has several resources that can help you find one in your area.

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

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

You have a right to appeal your insurance’s decision (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 details from follow-ups. Make note of when you do this and what is said.

“It may involve getting doctors to write a note, compiling medical research to support the decision, writing a personal statement,” said Ragen Chastain, a fat activist, researcher and writer who has a newsletter and workshops on topics like weight stigma. If that doesn’t work, she said, you can get an attorney involved.

The process may take a while, but persistence is key. It might (eventually) get you coverage.

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

If you have to pay for the medicine or procedure without insurance, know 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.

• Health care 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 staff about payment plans (some of which don’t charge interest).

Everybody deserves respect, regardless of their weight. Unfortunately, some people don’t recognize that — and it’s OK to not be OK with that. “If you’ve been denied medical care due to your weight, you have every right to be angry, upset and anything else you’re feeling,” Byrne said. “It’s inhumane.”

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

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

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

If you can’t access therapy due to cost, your location or another reason, finding someone else who understands — a professional on Instagram, a friend — can be beneficial, too. To find people to follow on social media, search terms like “fat liberation,” “anti-diet” and “HAES.”

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

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

The health care system fails people in larger bodies, then blames them for it. “It can fault and punish higher-weight people in which the health care system fails to accommodate them with research, tools, best practices and pharmaceuticals that are focused on thin bodies,” Chastain said.

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

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

Fat people are suffering because of a lack of respect in health care. “If someone believes that a fat person’s surgical outcome for, say, a total knee replacement, won’t be as good as that of a thin person, that doesn’t justify leaving fat people to suffer with no relief at all,” Chastain added.

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

“To be clear, you should not have to fight for the standard of care treatment simply because of your size, but until the culture of health care changes (which many outstanding advocates are trying to do), you may be forced into a position to defend your humanity in a system that continues to ignore the harms being done,” Landes said. “And for that, I am sorry.”