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Insurance Information and Costs
Having a weight-related illness or risk factor may increase your chances of
being reimbursed, but it is possible that you will have to pay for XENICAL
yourself.
Evaluate the True Costs of Being Overweight
It's important to consider the many benefits of losing weight when deciding
whether any out-of-pocket expenses are worth the cost. For instance, if your
weight is aggravating another health condition, such as arthritis, you may
be spending additional money on pain relievers. Some people try special
eating plans and nonprescription supplements to help them lose weight, but
these can be costly and ineffective.
Every year, Americans spend almost $70 billion on weight-related health
complications. Another $33 billion is spent on weight-loss products and
programs, most of which comes right out of consumers' pockets.
Request Reimbursement
Even if you decide to purchase XENICAL on your own, you can question your
insurance company's decision not to provide coverage or reimbursement for
weight-loss treatments. Remember, obesity is a chronic medical condition
that can lead to other serious, costly medical conditions. Studies show that
even modest weight loss of 5% to 10% of your body weight can reduce these
risks, improve your health and, in turn, lower the cost of your health care.
Knowing this, you can be confident that your request for coverage of a
proven weight-loss treatment is valid.
If you discover that your insurance company will not cover XENICAL, you may want
to find out why and to ask the decision-makers to reconsider. Here are some things
you can do:
- Call your insurance company's toll-free phone number.
In most cases you will speak with a customer service
representative or his or her manager.
- Keep good records.
Write down the dates and times you speak with customer
service representatives, along with their names and the information that you
are given. Keep copies of all written correspondence with your insurance company.
- Submit your request in writing.
Enclose copies of receipts for treatments not reimbursed,
medical test results and statements from your doctor. Make sure you clearly
state your name and policy number.
Click
here to fill in a pre-written letter to send to your insurance company
requesting coverage in advance. If you've already submitted a request for
coverage and have been denied, click
here to send your insurance company a letter appealing their decision.
- Ask your human resources or benefits manager for
guidance.
If you receive your health insurance through your
employer, your HR manager may be able to act as a liaison between you and
the insurance company. Make sure you keep those in the department informed.
Share copies of all your correspondence with the insurance company with them.
- Ask someone from your doctor's office (an office
administrator, nurse or even the doctor) to speak with your insurance company
on your behalf.
He or she can explain to your insurance company why
XENICAL is appropriate for you, why your weight is a health concern and how
your weight contributes to other health conditions and risks.
- Do some research.
Find out if other health insurance companies are covering
weight-loss treatments like XENICAL. Mention those that do to your insurance
company. Like any business, insurers must keep up with the competition in
order to survive.
- Follow up often.
It's easy for your request to get lost in the shuffle,
so be sure to keep in touch with your insurance company. Call or write to
make sure your request is being processed and that the appropriate people
have received your letters, your doctor's statements and any other materials
that support your case.
- Don't give up.
Your request may be rejected. If so, try again. Persistence
can pay off. At some insurance companies, a customer's third request automatically
gets transferred to a higher authority, so be sure to try at least three times.
- Ask about the appeals process.
If your case is rejected, you may be able to "appeal."
This process can be time-consuming but is likely to eventually lead you to
the true decision-makers - those responsible for setting policies about coverage
and reimbursement issues. Titles may vary, but try asking for a medical appeals
officer, a case management nurse or the medical director.
- Write to elected state and federal officials, who
may be able to assist you in the appeals process.
Explain your situation and ask for their support.
Petitioning political figures can help too.
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