Insurance providers face lawsuits over obesity coverage
The Washington State Health Care Authority and Regence Blueshield are accused of unlawfully excluding obesity treatments like Ozempic.
SEATTLE — Two class-action lawsuits were filed against health insurance companies that are accused of engaging in disability discrimination by excluding coverage for obesity treatments like Ozempic.
Sirianni Youtz Spoonemore Hamburger (SYSH) is representing the groups in both lawsuits, one of which is filed against the Washington state Health Care Authority, and the other is against Regence Blueshield.
“We have strong health insurance anti-discrimination laws on the books, but health plans ignore them when it comes to treatment for obesity,” said Rick Spoonemore of SYSH in a press release. “Excluding effective treatment for obesity makes no sense legally, medically or financially.”
Simonton v. Washington state Health Care Authority was filed in Thurston County Superior Court on behalf of Jeanette Simonton and a class of similar individuals. Simonton said her coverage excludes Ozempic and other prescription drugs to treat obesity, so she has had to pay out of pocket for the treatment.
“It is discrimination to deny medically indicated treatment that my physician prescribed just because it treats obesity,” Simonton said in the release. “There is no scientific or medical basis for this exclusion, plain and simple.”
The Washington state Health Care Authority said it does not comment on active litigation.
Solorio v. Regence Blueshield concerns a woman who had a bariatric surgery covered by a previous health insurance provider. She had a follow-up surgery that was not covered years later when she was covered by Regence.
Lynette Solorio needed a “medically necessary” surgery that was not covered by Regence because it was related to her previous obesity treatment, which the company excluded from her coverage.
“When I needed surgery in 2022, it was essential and lifesaving,” Solorio said in the release. “I paid my premiums to Regence like everyone else. My surgery should have been covered because it was medically necessary.”
In a motion to dismiss filed July 28, Regence BlueShield said Washington law allows insurers to exclude coverage for weight loss and obesity treatment, arguing the company shouldn’t be held liable. In a statement, the company said some insurance plans may include coverage for weight loss treatment while others do not.
“We regularly review our policies based on evidence-based medical data as well as the market and what is offered by other plans,” Regence BlueShield said in a statement. “Insurance coverage requires trade-offs in terms of determining the services most in need of coverage while keeping member premiums at a reasonable level.”
Regence BlueShield also argued in the motion that this isn’t a disability discrimination case, because the exclusion applies to all insured people equally, whether they are disabled or not.
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