Deborah D. Gordon has spent her career trying to level the playing field for healthcare consumers. She is co-founder of Umbra Health Advocacy, a marketplace for patient advocacy services, and co-director of the Alliance of Professional Health Advocates, the premiere membership organization for independent advocates. She is the author of "The Health Care Consumer's Manifesto: How to Get the Most for Your Money," based on consumer research she conducted as a senior fellow in the Harvard Kennedy School's Mossavar-Rahmani Center for Business and Government. Deb previously spent more than two decades in healthcare leadership roles, including chief marketing officer for a Massachusetts health plan and CEO of a health technology company. Deb is an Aspen Institute Health Innovators Fellow, an Eisenhower Fellow and a Boston Business Journal 40-under-40 honoree. Her contributions have appeared in JAMA Network Open, the Harvard Business Review blog, USA Today, RealClear Politics, The Hill and Managed Care Magazine. She earned a BA in bioethics from Brown University and an MBA with distinction from Harvard Business School.Full Bio
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If you live with obesity, getting the medical care and other support you deserve can be tough. Insurance may not cover all the latest treatments or special programs. And your costs can really add up if your insurance plan doesn’t cover the services you need.
Treatments for obesity may include:
- Anti-obesity medications
- Nutritional counseling or other therapy
- Weight loss programs
- Prescription digital therapeutics (PDTs)
- Weight loss surgery
- Consultation and care from obesity specialists
If your plan doesn’t offer these treatments or services, you can still ask your human resources or benefits administrator to help you get coverage on an exception 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 happens one to three years in advance, so it may take some time to see results.
Use this sample letter to ask your employer to cover your care. Feel free to change the wording to fit your style and situation. Be sure to customize the content within the brackets to specifically address what you need.
To write the most effective letter possible, follow these steps:
- Prepare by researching the health insurance policy you’re enrolled in or considering.
- Gather your prescriptions and healthcare provider recommendations so you can be very specific in your request.
- Calculate what you’ve had to spend on your own care for obesity care, along with the impact on your overall health and well-being. Include non-medical costs, such as transportation and time away from work.
- Use this information to make the case that improved coverage will improve your life, your health and your ability to perform at work.
Be respectful and approach your employer in a spirit of partnership. And trust that you share the same goal: for every employee to be able to contribute their best to the company and to live their best lives.
First and Last Name
City, State and ZIP Code
Date (when you send the letter)
Benefits or Human Resources Representative First and Last Name
Company Street Address
Company City, State and ZIP Code
Dear [benefits or human resources representative name],
I am writing to ask you for help with health insurance coverage for medical care that I need. I appreciate the generous health benefits that [insert company’s name] offers. Still, some of the care that I need is not accessible or affordable.
I live with the disease of obesity and I need [describe the treatment you want to get or the specialist you want to see. Note if your healthcare provider has prescribed or recommended a specific program, treatment, drug or referral to a nutritionist or other specialist].
I recently learned that our insurance plan, [insert insurance company name and specific insurance plan you’re on or are considering signing up for], does not cover the treatment that I am seeking.
This treatment has the potential to improve my health, well-being and overall quality of life. [Describe how obesity has affected you, 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 because of obesity or related conditions. Include the cost of treatments and medications due to obesity and related conditions. State if the costs create a hardship for you.]
I know that I am 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 state], that rate is [insert the percentage you find].
Studies show that overall, medical costs related to this disease are an estimated $173 billion each year in the United States. For each individual with obesity, medical costs are nearly $1,900 higher than for people who do not have obesity.
People with obesity have higher medical costs because we tend to have more health problems. Obesity has been linked to diabetes, heart disease and cancer, among others. These conditions can be serious and costly — even deadly. Treating obesity not only improves and saves lives, it helps lower healthcare costs for individuals and employers.
Obesity is now widely recognized as a medical condition. It’s important to have a range of obesity treatments available, accessible and affordable because not every treatment or approach works 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 lead to new treatments all the time. People with obesity 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 or treatment or provider you need], through an exception process or otherwise. Ideally, I would love to see our company support all people living with obesity by adjusting the benefits package overall to cover more obesity-related treatments, services and providers and to provide the option for flexible spending accounts (FSA) or health savings accounts (HSA) for obesity care.
Thank you for your consideration. Please let me know how we might work together to help me get the coverage I need and what the best next steps are.
[Your first and last name]
This educational resource was created with support from Eli Lilly and Company.
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