I’m a morbidly obese woman who is suing my health insurer for $700,000 because they refused to cover my weight-loss surgery
A woman is suing her health insurance company for $700,000 for refusing to cover her obesity treatment and claiming she owes them.
Luci ‘Lynette’ Solorio is suing Regence Blueshield over claims it is refusing to provide her with the ‘lifesaving’ bariatric surgery she had in 2017.
At the time she got the initial op she was covered by her insurer at the time, Anthem Blue Cross and Blue Shield.
Four years later, she needed to have a follow-up operation. According to a lawsuit she filed in Washington state court in June, Ms Solorio’s new insurer would not cover it because it was linked to her previous obesity treatment.
‘When I needed surgery in 2022, it was essential and lifesaving,’ Ms Solorio said in a statement released Tuesday by her lawyer, Rick Spoonemore.
‘I paid my premiums to Regence like everyone else. My surgery should have been covered because it was medically necessary.’
Luci Solorio is suing her health insurance company for refusing to cover her obesity treatment and claiming she owes them almost three-quarters of a million dollars (stock pic)
Ms Solorio claims in the lawsuit that Regence’s actions were ‘illegal and unreasonable’ under Washington state law.
Because of Regence denying coverage, Ms Solorio claims she owes more than $700,000 to multiple medical providers and the hospital where she had the follow-up surgery.
Ms Solorio sought treatment for her diagnosed morbid obesity in 2017.
She had sleeve gastrectomy surgery, where a large part of the stomach is removed and left behind is a narrow ‘sleeve’.
The surgery was pre-approved to be covered by Anthem Blue Cross.
The operation was successful, and she was able to lose enough weight to keep her BMI below 30.
She also had a pre-existing diagnosis of gastroesophageal reflux disease (GERD), when stomach acid repeatedly flows back into the esophagus.
In September 2021, she had more surgery to convert her gastric sleeve to Roux-en-Y gastric bypass, in the hopes of solving her chronic GERD.
Roux-en-Y gastric bypass is another type of weight-loss surgery, where small incisions are made in the abdomen to reduce the size of the upper stomach to around that of an egg.
‘The surgery Solorio required was medically necessary under the Regence Bariatric Surgery clinical guidelines,’ the lawsuit said.
A staggering amount of Americans (42 percent of adults) are obese. Most insurers cover bariatric surgery, which reduces the amount of food a patient can eat by shrinking the size of the stomach.
But patients may still have to meet certain criteria to qualify, and less than half of employers cover bariatric surgery within their workplace health insurance policies.
Even fewer insurers cover new drugs like Wegovy and Ozempic that don’t require surgery to lose weight. Medicaid and Medicare do not.
According to a benefits consultant cited by the Associated Press, less than half of employers’ health insurance plans cover obesity drugs.
Companies stopped covering the drugs because they are very expensive, costing up to $1,300 a month for each patient.
Ms Solorio’s lawsuit is one of two recent cases confronting insurers for not covering obesity treatments.
Jeannette Simonton, from Kittitas County, Washington, was insured under Washington State Health Care Authority, which does not cover any obesity treatments.
After paying for her Ozempic prescription herself, she sued the insurer in September 2023.
Under Washington state law, obesity is categorized as a disability. Both lawsuits argue the rejection of the coverage is an unlawful form of discrimination.
Ms Simonton said: ‘It is discrimination to deny medically indicated treatment that my physician prescribed just because it treats obesity.
‘There is no scientific or medical basis for this exclusion, plain and simple.’
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I’m a morbidly obese woman who is suing my health insurer for $700,000 because they refused to cover my weight-loss surgery
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