In what’s believed to be a first in the US, two insurance companies are being sued in Washington state for refusing to cover weight-loss treatments, including popular new weight-loss drugs.
In one case, a woman is suing her public employee plan under the state’s Health Care Authority because it won’t cover weight-loss drugs.
She’s paying for Ozempic out of her own pocket.
In a second case, a woman is suing Regence BlueShield for refusing to cover follow-up care for her weight-loss surgery.
She owes $700,000 for the additional surgery.
“In (Washington), obesity is recognised as a disability by the Washington State Supreme Court,” said attorney Rick Spoonemore. He represents both plaintiffs.
The Washington State Health Care Authority says it cannot comment on active litigation.
In a statement, Regence BlueShield told KIRO Newsradio: “In accordance with (Washington) law, some of our health plans include a weight loss exclusion, while other plans may include coverage for various types of weight loss treatments.
The company said it regularly reviews its policies. “Coverage requires trade-offs in determining the services most in need of coverage while keeping member premiums at a reasonable level,” it added.
Spoonemore claimed that insurers often cite cost as a reason for denying treatment, especially new drugs.
But he argued that the cost of drugs often comes down over time, especially as generics become available. He added that treating obesity now would save money later.
“You’re not going to have to pay health care costs for cancer or heart disease, heart disease, knee replacements, years down the road,” Spoonemore said.
According to the Centers for Disease Control and Prevention, obesity is associated with a higher risk of developing 13 types of cancer. The National Institutes of Health says obesity increases the risk of stroke and heart failure.
The American Academy of Orthopedic Surgeons says heavier people are more likely to need total hip and knee replacements than patients with a normal body mass index.
Few dispute the risks associated with being overweight, but Spoonemore believes that long-held beliefs about why people become and remain obese may be a factor when insurers deny coverage for weight-loss treatment.
“The idea that it’s all about willpower and self-control (is not true),” Spoonemore said. “The fact is that science has now caught up with this bias. As we know from science, it goes way, way beyond that.”
The lawsuits are seeking class action status. If granted, the suits would include other people who’ve been denied coverage for similar weight-loss drugs and surgeries.
