Episode Details

Transcript:

In part one we talked about the issues with BMI-based denials. Today we’ll talk about your options if you are facing a BMI-based healthcare denial. Part three will be the story of someone who successfully fought these denials.

First of all, if your healthcare is being held hostage unless/until you reach a certain BMI (or lose a specific amount of weight etc.), please know that this is not your fault, even though it’s becoming your problem. Your options include finding different circumstances, fighting the denial, or trying to reach the BMI requirement. We’ll talk about each of these in turn. Note that, while the advice here may be helpful in other places, it is predominantly focused on the US experience and that it is generalized options and, as everything in this newsletter, is not medical advice.

And remember, unfortunately you are not in control of the situation, so if you are not successful, that’s not because you did anything wrong, it’s because the system is rooted in weight stigma and really messed up.

The basics

The first place to start is by finding out as much as you can about the denial. If possible, you want to get this information in writing (for example, by sending emails or utilizing a patient portal like MyChart,) or recorded (you can try saying something like “I’m afraid I won’t be able to remember everything from the appointment, do you mind if I record it?”) You can also bring someone along to take accurate notes.

Collecting as much information as you can upfront can make future steps easier. Just as a reminder, this situation should not happen. It is absolutely unfair that fat people should have to fight for the treatment that thin people get. Even if this is becoming your problem, it is not your fault. Here are some questions to start with:

Where is the denial coming from?

* It is typically the surgeon, anesthesiologist, facility, or insurance

What are they claiming is the reason for the denial?

* Is it anesthesia risk? Risk of complications with the surgery? Concerns about recovery time/complications? Concerns about outcomes not being as good as a thinner person’s outcomes?

* Rather than offering up these explanations, you can ask more circumspectly - “what concern is at the root of the denial?” Again, try to get this answer down verbatim.

What are they hoping that weight loss will do?

* This is typically tied to the answer to the question above. Getting the answer to this can be very helpful if you decide to fight the denial.

Ok, let’s look at the three main options to handle these denials. Before I start I do want to be clear that aspects of privilege, socioeconomic status, and intersectional oppression pervade all of these options and have the greatest impact on those of the highest weights and/or who are multiply marginalized.

Option 1: Finding different circumstances

Start with the information you gathered about the source of the denial. Here the fact that these limits are often applied utterly inconsistently can be helpful.

If it’s the surgeon, you can try to find another practitioner. A place to start is Mary Lambert’s Weight Neutral Provider list.

If it’s the anesthesiologist, you can see what the options are to get another anesthesiologist. One option is to ask if they offer weight loss surgery in the facility and, if so, if one of those anesthesiologists can do the anesthesia for your surgery. (This can be particularly helpful in situations where someone has been denied a surgery that they actually need/want because of anesthesia risk, and has then been referred to weight loss surgery.)

If it’s the facility, you can see if the surgeon you want to work with has privileges at other facilities that might have diff