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?

  • ccunning@lemmy.world
    5·
    6 hours ago

    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.