Let me explain with my current situation. I am 22 F and I currently weigh 305lbs.
I am obese. Morbidly obese.
Even though I have been trying for 5 years at this point to lose the weight on my own. Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.
But I still am not losing the weight. I am still very fat. And I am worried that it will cause very serious health problems.
So I talked with my doctor and she told me “We need to get you on a weight loss medication. Let’s try Ozempic”.
But my insurance told us that they don’t think I need the Ozempic so they won’t pay for it.
So we tried Wegovy and Mounjaro. But my insurance still rejected our requests.
They’re saying because I am young, and I am a diabetic with good numbers, I dont need the weight loss meds and I can just lose the weight naturally.
But ive been trying to and it hasn’t been working. So that’s why my doctor prescribed me the weight loss med.
Why is this allowed? Why is it that your insurance can deny you a medication, even if your doctor says you need it?
This sucks, and I’m sorry, but you missed one crucial thing.
Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more
Have you tried eating less? Fruits and veggies give you good nutrition, working out builds muscle, but the only thing you can do to actually lose weight is to eat less.
Money and the power of “fuck you”.
:(
The insurance companies want to make money.
There are no (enforced) laws prohibiting this behavior.
Very few insurance company decision makers are murdered in the street.
Change one or more of these, and you’ll get better results.
The insurance company is going to have a doctor who said you don’t need it. They will try to hide who that doctor is, specifically what their NPI is, which can be used to personally identify the doctor who made the medical judgement against your doctor’s without having to provide further explanation than they’ve already given. Depending where you are they may have to provide more information when directly asked for specific evidences, or will suddenly change their rejection on the claim with a letter from an attorney asking for specific details in writing. They know hiring an attorney is expensive and bank on people not advocating for their rights & people with severe medical issues not being able to afford to.
And lastly a video of a surgeon being denied the NPI of the insurance’s doctors who are likely breaking the law hiding behind the idea that insurance doctors are so hated they need to hide their identity even from other doctors to prevent reprisal. She was blacklisted from United claims for this video and others like it.
Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.
Not to say you should be denied prescription coverage, but that is not the whole kit and caboodle. Weight loss results from consuming less calories; specifically, less than you are burning. You can lose weight on a completely unhealthy diet and without any extra effort to exercise.
Yep, this. I’m like 130 lbs and I literally sit around all day and I eat garbage. But just a little garbage.
What a pointless post.
Oh, I know the answer to this one. It’s because we don’t have single-payer healthcare, which Republicans don’t want because they don’t want bureaucratic death panels of disconnected doctors denying people access to medication.
They’d much prefer to have bureaucratic death panels entirely disconnected from any medical expertise denying people access to their medication and for spurious reasons.
It’s quite simple:
They are money-grubbing assholes in an unregulated industry. Their goal is to make as much money as possible while hurting as many people as possible. Because if they hurt people, they can take their money and provide no service.
It’s legal because the government won’t make it illegal.
Monied interests have crafted a legal system that benefits them, not you.
I hate that this is happening to you.
Darknet Markets are booming with semaglutides because of capitalism’s greed.
This is what pushed Luigi to allegedly merc one of them
What do you mean, Luigi was at my place playing xbox games when that guy got killed.
Can confirm. I was playing with both of them online, and Luigi and I were making lewd comments about lemmyng’s mom.
That was so rude, but also hilarious. It was a big lobby that night, but Luigi was really keeping everyone chill.
yep, I was there too.
Allegedly ☝️
Because Fuck You, that’s why.
Mounjaro and Ozempic both have savings cards you can sign up for on their respective websites, as long as you aren’t on government insurance.
I had the same issue last year, my A1C was 6.9 and insurance denied coverage. I got the savings card from Lilly, had my doctor call in the script and BAM! 25USD for 12 weeks of Mounjaro.
I didn’t even need a prior authorization anymore. Apparently results may vary, but I got lucky. Try them both if needed. Stay vigilant!
You can get wegovy 28-day of the auto injectors through Amazon pharmacy for $200 a month without insurance. It still requires a prescription, but it sounds like you have that.
Obviously it would be better if your insurance would cover it, but $200 a month is better than the $600 a month some people are paying for ozempic/etc.
When signing up for insurance, you’ll want to check their approved medications. My wife was prescribed mounjaro for her diabetes, but most of the insurance plans we looked at didn’t have it listed as one of their approved medicines. It was one of the largest factors in deciding which insurance we needed to go with.
My wife was prescribed one of those for her diabetes, and the insurance company STILL wouldn’t cover a dime. She was able to find a coupon for a three month supply for $350.
And see, that’s what my problem was
Yes, I am technically a type-2 diabetic, but i am a diabetic with good numbers, so my insurance is saying "oh we wont pay for those meds. You don’t need it."🙄😒
Unfortunately, the answer is to move to a country that’s not a shit hole and has universal healthcare. The next best is to do what you can to survive while you try to convince people to vote with you for a gov’t that will give you universal healthcare.
Right now? I can’t imagine what you’re going through and I really am sorry I can’t help directly. Your system is broken. Your gov’t has failed you. I really, truly and honestly, wish you the best and hope you find the help you need.
Because the filthy rich don’t care if anyone dies.
They care if a rich person dies. My friend Luigi proved that.
Allegedly. Could have been anyone. More people had a motive than would fit into a police database.
They can’t, they can only deny coverage for it. You can still get it paying for it yourself.
Yeah, paying $200+ a week for a shot. In this economy?
I don’t know anyone who has that kind of money
I’m not saying it’s right, I’m just saying it’s so.
Health Insurance CEO
The intended goal of conservative voters is to ignore your plight and they’d like you to die off screen.
I just went through this battle myself. And my insurance even approved it, but I’m traveling overseas for two months and even though they tell me my benefit covers a “vacation override” they wouldn’t approve it.
I asked the pharmacy how much it would cost to pay out of pocket. $1300 for 4 weeks, so $2600 to cover my trip.
Luckily my Dr was able to give me “samples” to get me through my trip.
Also, another thing that I learned in the past year. What your insurance will cover and how much they’ll cover changes depending on your history.
Spend a three day weekend in the ER/ICU and suddenly I DO need Ozempic and they’re giving me thousands of dollars worth of CGMs for free.
It’s all a cost/benefit analysis for them.
Here in NZ it’s less than usd $300 a month full cost, but usually funded by the govt.
Not always. Sometimes, companies won’t sell it to you if your insurance has denied it. They may say it’s because they don’t believe you can afford it.
