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

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.

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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.

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