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
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.
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 guy is so photogenic, it’s insane
he bulked up in jail apparently too.
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.
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 ☝️
Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too
isnt also because alcohol industry is lobbying against it, because omezpic also reduces your “desire” for addictions.
and McDonalds.
no way this skinny CEO eats that shit.
He swallowed some of the juice, he’ll taste that for weeks.
You gotta love the wince developing on the left side of his face as he chokes down his promo nibble.
no way this skinny CEO eats that shit
I think “Super Size Me” touched on this. Calories in the burger aren’t as impactful as calories in the fries and drink.
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?
Oh no! Not the health
careinsurance industry.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."🙄😒
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Three months for 350 is pretty good, here it’s 500 a month.
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.
apparently you can use coupons for the pharmacy in amazon to lower the price evenmore. i wonder of goodrx works on it.
Clown ass country where we need coupons for medicine
Sadly that’s only (or mostly) in America. Here we get whatever meds the dr says. Most common ones are subsidized by the government (via taxes yes).
My idea of Ameroca was already wild but finding out you gotta convince an insurance company you pay that you need medicine a dr prescribes is crazy.
Oh and we get pretty much all blood tests and stays for free. GP one day, scan/test the same day (different location but some have them next door) then back at the GP by the end of the week with results and get your meds. Done.
Sorry OP.
Because everything in America is a privatized scam and the regulatory agencies are being completely dismantled
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
Health Insurance CEO
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.
The intended goal of conservative voters is to ignore your plight and they’d like you to die off screen.
imagine trying to get approval for biologics, which can thousands a month.
I’m not saying it’s right, I’m just saying it’s so.
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.
Because profit margin. There’s no deeper reason than that.
Doctors are concerned with your health.
Health insurance companies are concerned with the stock price.
These are conflicting goals.
Luigi…
