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 claims she owes them.

Luci ‘Lynette’ Solorio is suing Regence Blueshield over claims it is refusing to provide her with the ‘life-saving’ bariatric surgery she had in 2017.

When she had the initial surgery, she was covered by her insurer at the time, Anthem Blue Cross and Blue Shield.

Four years later, she had to undergo 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 necessary and life-saving,” Ms. Solorio said in a statement released Tuesday by her attorney, 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, claiming she owes them nearly three-quarters of a million dollars (stock photo)

Ms. Solorio claims in the lawsuit that Regence’s actions were “unlawful and unreasonable” under Washington law.

Because Regence denied coverage, Ms. Solorio claims she owes more than $700,000 to various medical providers and the hospital where she had the follow-up surgery.

In 2017 Ms Solorio sought treatment for her diagnosed morbid obesity.

She had sleeve gastrectomy surgery, where a large part of the stomach is removed and a narrow ‘sleeve’ is left behind.

The surgery is pre-approved to be covered by Anthem Blue Cross.

The surgery 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 underwent another operation changed her gastric sleeve to Roux-en-Y gastric bypass, hoping to resolve 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 about 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 reducing the size of the stomach.

But patients may still have to meet certain criteria to qualify, and fewer 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 have 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, of Kittitas County, Washington, was insured under the Washington State Health Care Authority, which does not cover 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 denial of coverage is an illegal form of discrimination.

Ms Simonton said: ‘It is discrimination to refuse medically indicated treatment prescribed by my doctor just because it treats obesity.

“There is no scientific or medical basis for this exclusion, plain and simple.”