How to Ask Your Employer for Obesity Insurance Coverage

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If you’re living with obesity, it can be difficult to get the medical care and other supports you deserve. Insurance may not cover all latest treatments or special programs. And your costs can add up if your insurance plan doesn’t cover the services you need.

Treatments for obesity may include:

• Obesity medications
• Nutritional counseling or other therapy
• Weight loss programs
• Prescription Digital Therapy (PDT)
• Bariatric surgery
• Consultation and care by obesity specialists

If your plan does not offer these treatments or services, you can always ask your human resources or benefits administrator to help you obtain coverage on an exceptional basis. They might consider adding coverage to the benefits package for everyone when they update benefits for next year, but it’s important to know that employer-sponsored benefit design often produced one to three years in advance, so results may take some time.

Use this sample letter to ask your employer to cover your care. Feel free to change the wording to suit your style and situation. Be sure to customize the content in parentheses to specifically address what you need.

To write the most effective letter possible, follow these steps:

• Prepare by researching the health insurance policy you are enrolled in or considering.
• Gather your prescriptions and recommendations from your healthcare providers so you can be very specific in your request.
• Calculate what you have had to spend on your own obesity-related care, as well as the impact on your overall health and well-being. Include non-medical expenses, such as transportation and time off work.
• Use this information to demonstrate that better coverage will improve your life, your health and your ability to work.

Be respectful and approach your employer in a spirit of partnership. And know that you share the same goal: that each employee can bring the best of themselves to the company and live their best life.

First and last name
Street address
City, State and Zip Code
Phone number

Date (when you send the letter)

First and last name of benefits or human resources representative

Job title
Company Name
Company mailing address
Company city, state, and zip code

Dear (name of benefits or human resources representative),

I am writing to you to request assistance regarding health insurance coverage for the medical care I need. I appreciate the generous health benefits that (insert company name) offers. Yet some of the care I need is not accessible or affordable.

I live with the disease of obesity and I need (describe the treatment you wish to receive or the specialist you wish to consult. Note whether your healthcare professional has prescribed or recommended a specific program, treatment, medication, or referral to a nutritionist or other specialist.).

I recently learned that our insurance plan, (insert the name of the insurance company and the specific insurance plan you subscribe to or plan to subscribe to), does not cover the treatment I am looking for.

This treatment has the potential to improve my overall health, well-being and quality of life. (Describe how obesity has affected your health and well-being. Explain any conditions you may have that are related to or caused by obesity. Share details of any treatment or medication you need due to obesity or related conditions. Include the cost of treatments and medications related to obesity and related conditions. Indicate whether the costs create difficulties for you.)

I know I’m not alone. In the United States, 42% of adults live with obesity, according to the CDC. (If you want to add the obesity rate in your state, FIND YOUR STATE HERE and add: In (your condition), this rate is (insert the percentage you find).

Studies show that overall, medical costs related to this disease are estimated at $173 billion each year in the United States. For each obese person, medical costs are nearly $1,900 higher than for non-obese people.

Obese people have higher medical costs because we tend to have more health problems. Obesity has been linked to diabetes, heart disease and cancer, among other things. These conditions can be serious and costly, even fatal. Treating obesity not only improves and saves lives, but also helps reduce health care costs for individuals and employers.

Obesity is now widely recognized as a medical condition. It is important to have a range of accessible and affordable obesity treatments, as not every treatment or approach is suitable for everyone. People with obesity deserve access to the full range of clinically valid, FDA-approved treatments, just like people with any other disease. New scientific discoveries constantly lead to new treatments. Obese people should have access to new developments to have the best chance of managing and even beating this disease.

I respectfully request that you help me arrange coverage for (insert the service, treatment or provider you need), via an exception process or otherwise. Ideally, I would like to see our company support all people living with obesity by broadly adjusting the benefits package to cover more obesity-related treatments, services and providers and providing the option to have flexible spending accounts (FSA) or health savings accounts (HSA). ) for the management of obesity.

Thanks for your consideration. Please let me know how we could work together to help me get the coverage I need and what the best next steps are.

Sincerely,

(Your first and last name)

This educational resource was created with the supportort of Eli Lilly and Company.