Wash. lawsuits target insurance companies over weight-loss drugs, surgery

Oct 12, 2023, 11:02 AM | Updated: 11:02 am


Ozempic is now being used as a simply weight-loss drug. (Photo by JOEL SAGET / AFP) (Photo by JOEL SAGET/AFP via Getty Images)

(Photo by JOEL SAGET/AFP via Getty Images)

In what’s believed to be a first in the U.S., two insurance companies are being sued in the state of Washington 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 Health Care Authority because it won’t cover weight loss drugs.

She’s paying for Ozempic out of pocket.

In a second case, a woman is suing Regence BlueShield for declining to cover the follow-up treatment to her weight loss surgery.

She owes $700,000 for that additional surgery.

“In (Washington), obesity is recognized by the Washington State Supreme Court as a disability,” attorney Rick Spoonemore said. He is representing both plaintiffs.

“The health insurer — although it covers other medically necessary drugs for other conditions — says because you are obese, we’re going to exclude coverage. That is straight-up unfair discrimination under (Washington) law.”

The Washington State Health Care Authority says it cannot comment on active litigation.

From Micki Gamez: Weight loss content creators say they are being banned from TikTok

In a statement, Regence BlueShield told KIRO Newsradio, “In accord 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 treatment.”

The company said it regularly reviews its policies. “Insurance coverage requires trade-offs in terms of determining the services most in need of coverage while keeping member premiums at a reasonable level,” it added.

Spoonemore claimed insurers often cite cost as a reason to deny treatment, especially new drugs.

But he argued the costs of medicine often come down over time, especially as generics become available. He added treating obesity now saves money later.

“You’re not going to have to pay health care costs related to cancer or heart disease, heart conditions, knee replacements, years down the line,” Spoonemore said.

According to the Centers for Disease Control and Prevention, obesity is linked with a higher risk of getting 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 said heavier people are more likely to require total hip and knee replacements than patients with normal body mass indexes.

Few dispute the risks associated with being overweight but Spoonemore believes 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 will power and self-control (isn’t true),” Spoonemore said. “The fact of the matter is that science is now caught up with that bias. As we know from science, it goes far, far beyond that.”

The lawsuits are seeking “class action” status. If granted, the lawsuits would then include other individuals who’ve been denied insurance coverage for similar weight loss drugs and surgeries.

KIRO Newsradio

Photo: WA State Senator Mark Mullet (R-District 5)....

Frank Sumrall

John and Shari: Sen. Mullet speaks on banning nude deepfakes, running for governor

Sen. Mullet spoke with John and Shari on Washington's bill barring A.I.-generated deepfakes and his race for Washington's governor.

1 hour ago

Image: Buddy Booth is seen as a young adult. Episodes of Season 2 of The Letter from KSL Podcasts a...

Amy Donaldson - executive producer, KSL Podcasts

The Letter Season 2: Sense of dread precedes second 1982 Millcreek Canyon murder

The second episode of the second season of The Letter, "Ripple Effect," details the second man killed in a 1982 double murder.

2 hours ago

Photo: West Seattle High School students held a pro-Palestinian protest....

James Lynch

Western Washington students walk out against Israel-Hamas war

Around 100 West Seattle High School students joined other groups across the nation in protesting against the Israel-Hamas war.

4 hours ago

Photo: This photo, seen in December 2023, shows a series of tents lined the parking lot of Riverton...

Matt Markovich

Markovich: Elected officials need accountability for their ‘generosity’ with our tax dollars

When King County dug into its pocket and pulled out $2 million to help dozens of asylum seekers and refugees in Tukwila -- I took a pause.

7 hours ago

supreme court homelessness...

Kate Stone

As homelessness rises, Supreme Court takes Oregon case, to decide on sleeping bans

The Supreme Court will rule on if banning homeless people from sleeping outside when there's no shelter space is cruel and unusual.

1 day ago

Image: The exterior of a Kroger grocery store in Novi, Michigan, can be seen Jan. 23, 2021....

Heather Bosch

Kroger, Albertsons alter their merger plans, include Haggen in new deal

Kroger and Albertsons said Monday they will sell more stores to quell the federal government's concerns about their proposed merger.

1 day ago

Wash. lawsuits target insurance companies over weight-loss drugs, surgery