Weight Management and Health Insurance

Your health insurance company has a special interest in helping you stay healthy. Your good health keeps health care costs down for everyone. Being overweight raises your risk of costly health problems such as diabetes. But losing that excess weight lowers the risk to your health producing potential savings for both you and your insurance company.
It may surprise you then to discover that your health insurance plan will not pay for weight-loss treatments. Many health insurance plans will only pay for the costs of weight-related health problems after they develop.
Weight-loss treatments that prevent these problems in the first place or reduce their severity are often not reimbursable. You need to pay for them out of your own pocket.

Inadequate reimbursement for weight-loss treatment is an important issue that you may want to bring to the attention of your Health Insurance Company and/or employer.

If you would like to urge your health insurance company to help you pay for your weight-loss treatment, it's up to you to make your needs known. It's up to you to ask for the company's help in improving your chances of becoming a healthier person.

Have confidence in the fairness of your request.

Obesity is a chronic medical problem with serious complications. Even modest weight loss is likely to reduce your risk of complications, improve your health, and reduce healthcare costs. You're well within your rights as a valued customer to make this case to your insurance company.

Go through the proper channels within your insurance company.

Many health insurance companies offer you an "800" customer service number that you can call with complaints or requests. In most cases, the first person you contact at the insurance company is the customer service representative. This person should be familiar with your specific health plan.

If you would like to take your case beyond your insurer's customer service representative, you may wish to speak to one or more of the following individuals:
--the Manager of Customer Service
--the Director of Customer Service
--the Marketing Director for New Products or Program Development

Your employer's health benefits manager may be able to put you in contact with these individuals.

Don't hesitate to get your employer's health benefits department involved on your behalf.

Discuss your needs with your health benefits manager at work. Request his or her support in gaining reimbursement for your treatment. Your health benefits manager may be very experienced in negotiating with insurance companies, so you should carefully consider his or her recommendations. Many employers will support your efforts to be reimbursed for the treatment you need to stay healthy and productive.

Don't be confrontational, argumentative, or hostile when making your request or discussing your concerns. Do be assertive and persistent.

Maintain a "cool head," while clearly and firmly expressing your needs. Although you and your insurance company are both interested in keeping you as healthy as possible, you may encounter some resistance. Stick to your guns, even if company representatives are uncooperative or impolite.

Keep accurate and well-organized records of all communications with your insurance company.

Take careful notes when talking with company employees by telephone. Record dates, times and names and keep copies of all written correspondence.

Send the insurance company a written letter repeating your concerns and requests after any phone conversation with one of its representatives.

Keep your communications simple and to the point. Also, include all of the necessary information, such as your name, policy number, and other identification information. It's also a good idea to enclose copies of receipts for unreimbursed treatments, medical test results, and statements from your doctor.

Don't forget to follow up if you don't get the response you want the first time.

An insurance company representative may not be able to provide you with the information that you need right away. If so, ask that the representative follow up within a reasonable period.