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Obesity Treatment Insurance Denial Attorney
When you are dealing with an obesity treatment denied by insurance, you may experience frustration, even anger. After all, having a treatment denied that you and your doctor have determined will help you, can leave you feeling like there are no remaining options. You are aware that being overweight is risky for your health, and perhaps you have tried many different diets to lose weight and become healthier.
You also know that you have faithfully paid your health insurance premiums—in other words, you have held up your end of the contract, and now it feels like your insurer is not holding up its end. You need a strong advocate in your corner who will fight for your rights in the matter and will not allow your insurer to ignore its obligation to you. Attorney Scott Glovsky helps people in similar situations every day. Scott is fully committed to fighting for justice for clients who have received an insurance denial and takes that responsibility very seriously.
What Are Some of the Reasons Your Insurance Claim for Obesity Treatment Could Be Denied?
Some of the newer drugs used for obesity have shown impressive results yet are often denied by insurers even when prescribed by a patient’s doctor. Cost is a factor in some of the denials as the new drugs approved for obesity treatment can cost more than $1,500 per month. Many insurance companies are pushing back against coverage for any weight loss drug under the theory that obesity is not a disease, rather it is a behavioral problem.
Since few people can afford the obesity drugs on their own, it can be extremely disheartening to receive an insurance denial. Many of the newer weight-loss drugs were initially approved as treatments for diabetes but were found to aid in weight loss as well. And despite a growing body of evidence that obesity is not always caused by overeating,but can be the result of insulin resistance and hormonal issues, denials by insurers have been shown to significantly worsen existing health disparities.
Obesity rates are higher among those who live in poorer communities which typically have fewer grocery stores and may lack access to health care. Since this group of people cannot afford to pay out of pocket for obesity treatment drugs, those who really need the drugs may not be getting them thanks to insurance denials. These insurance denials can keep you or a loved one from getting a necessary obesity treatment that will improve overall health.
What Should You Do Following an Obesity Treatment Denied by Insurance?
If you are dealing with an obesity treatment denied by insurance, there are several things you can do. First, carefully read the denial letter you received from your insurer. Your denial could be due to using an out-of-network provider, failure to obtain precertification or preauthorization, or the treatment you received is not covered by your insurance. Insurers often attempt to deny a claim on the grounds that it is experimental or not yet approved for your specific medical issue. This may be particularly true in the case of obesity drugs that were initially approved for the treatment of diabetes.
If your insurer did not make a mistake when they denied your claim, your next step may be to file an internal appeal with your insurance company. Having a letter from your doctor explaining why the treatment, procedure, or medication was or is medically necessary can increase the chances of success for your appeal. If your internal appeal is denied, you have the right to file an external appeal where an independent review organization will review your claim and make a final decision that your insurer must honor. If you are feeling overwhelmed by the appeal process, the Law Offices of Scott Glovsky can help. We can assist with the necessary paperwork, ensuring all deadlines are properly met while fighting for your rights.
Which Health Insurance Companies Are Most Likely to Deny Obesity Treatments?
Although any health insurance company can potentially deny your obesity treatment, some insurers may be more likely to deny the treatment than others. Anthem Blue Cross,Blue Shield,Health Net,Kaiser,United Healthcare,Aetna, and others could have triggered your obesity treatment denied by insurance.
What Are Some of the Most Common Obesity Treatment Drugs on the Market?
The market for anti-obesity medications is large. In 2022, the market was valued at $2.82 billion, and Barclay’s projects that this market could reach $100 billion by 2030.
Some of the newest obesity treatment drugs on the market are known as GLP-1s. These drugs differ from older classes of prescription weight loss medications because they work on underlying metabolic pathways to support sustained, lasting weight loss. The most common GLP-1 drugs include semaglutide, sold under the brand names Wegovy and Ozempic, liraglutide, sold under the brand nameSaxenda, and tirzepatide with both GLP-1 receptor agonist and GIP, sold under the brand names Mounjaro® and Zepbound™. Although still in clinical trials, when Retatrutide is FDA-approved, it will join this list.
While these drugs were initially marketed for the treatment of diabetes, they have been shown to reduce inflammation markers while aiding in shifting the body’s set point—the weight your body fights to maintain. These drugs accomplish this by impacting areas in the brain that control cravings and the feeling of fullness. The drugs also increase your energy expenditure by slowing how quickly the foods you eat move from your stomach to your intestines. GLP-1s essentially improve whole-body energy metabolism by increasing insulin sensitivity and regulating fat cell development.
Has the FDA Approved Obesity Treatment Drugs?
In 2014, the FDA approved Saxenda (liraglutide) as a treatment for obesity and chronic weight management for adults. Then in 2021 it approved Saxenda for obese kids 12-17. In 2021, the FDA approved semaglutide injections under the brand-name Wegovy for chronic weight management in adults with obesity who also have at least one weight-related condition—Type 2 diabetes, high blood pressure, or high cholesterol. In November 2023, the FDA approved Zepbound (the same formula as Mounjaro) for obese adults and overweight adults who have at least one weight-related health condition. Liraglutide and semaglutide work by mimicking the hormone that targets the area of the brain that regulates food intake and appetite. Because these drugs are now FDA-approved for the treatment of obesity, it is more difficult for insurers to claim the drugs are experimental—although they could still try to do so in order to avoid paying for the drugs. Saxenda and Wegovy both have list prices of about $1,349 per month.
How the Law Offices of Scott Glovsky Can Help Following an Obesity Treatment Denied by Insurance
Following an obesity treatment denied by insurance, it is imperative that you contact an experienced attorney from the Law Offices of Scott Glovsky. The medication your doctor prescribed—and your insurer denied—could be incredibly important to your health and your future. Attorney Scott Glovsky recognizes this importance and will fight for your rights when your insurer denies your claim.
You, like most Americans, have paid your insurance premiums to protect you and your family members, trusting your insurer will be there for you in your time of need. Unfortunately, insurance companies are rarely as helpful and friendly as they appear to be in television ads and, in fact, are primarily interested in their financial bottom line. The goal of most insurers is to make money. In furtherance of that quest, your insurer may actively seek loopholes that will allow them to deny claims. Scott Glovsky will take on any act of bad faith by an insurance company, forcing the company to fulfill its promises to you. Contact the Law Offices of Scott Glovsky today for a free case evaluation.
