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?
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.
They argue that they are preventing waste and fraud by holding doctors accountable. Like “oh if we didn’t have this power then doctors would order so many unnecessary tests and prescriptions”
(Not defending them, just sharing what they say)
Yeah, and what they say is bullshit. Doctors prescribe the medicine people need.
They don’t care about fraud. They care about their profits. We shouldn’t repeat their excuses like that.
If that was the case we’d have one of the most efficient medical systems in the world instead of one of the least
Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too
This is what pushed Luigi to allegedly merc one of them
Money and the power of “fuck you”.
:(
Nunber 1: Ozempic is NOT a weight loss drug.
Ozempic is a diabetes management drug that has a potential side-effect of weight loss.
The reason that you are likely being denied for Ozempic by your insurance is because you likely lack the diabetes with the additional comorbidities. You shared that you are diabetic with good numbers.
If you had worse diabetes and additional issues (comorbidities) such as high risk for stroke or heart attack by (very) high unmanaged blood pressure, then you could appeal the insurance company to cover the drug.
Number 2: the struggle is real. I highly recommend you fight this and continue your weight loss journey. Diabetes is unbelievably complicating later in life.
US healthcare will go broke covering $350/mo drugs to counteract lifestyle choices. 15M already on this drug, that’s $5.25B a month.
Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
Good. Fuck em all and replace the whole thing with a system that works.
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.
Three months for 350 is pretty good, here it’s 500 a month.
It’s not allowed, but then again, I’m not in the US.
Because everything in America is a privatized scam and the regulatory agencies are being completely dismantled
Luigi…
The is healthcare system is clearly a disaster but …. Since those drugs are not approved treatment for a health issue you have (your diabetes is under control), they have. Bit of an excuse. The real reason of course is that most of the population is overweight so they can’t afford to pay for everyone who needs it.
Can I suggest other strategies that may help you lose weight?
When I was planning to have kids I successfully lost over 100 pounds and kept it off for a decade! For me the key factors were doing it with my wife so we kept each other on track and food tracking. We joined weight watchers but it was the food tracking that made the difference for me and there’s many ways to do that. Even when you think you’re doing well you probably consume a lot more calories than you think, and it adds up. Food tracking can highlight this, identify where to make more effort. On the other side of things, losing weight requires following good habits over time: food tracking also helps you stay on track over time but this is also where peer pressure from someone else can really help.
Of course I’ve gained it all back now that my kids are in college but I did pretty well for their entire childhood, which was my motivation. I currently may have better nutritional habits than I did back then but I’m clearly way off in portion size and calories consumed
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!
I am on government insurance.
Because “business” and “dollar amounts” are more important than human life (some human life anyway).
Capitalism and actuarial science. Their models likely show that you are still young enough for them to keep you fat for a few years while the cost of GLP1s go down.
Because the filthy rich don’t care if anyone dies.
deleted by creator
