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?
Im going to go out on a limb and assume you are from the us. us healthcare is nuts. Here is the funny thing. My wife has thyroid issues. Her bloodtests shows it within normal but on the low end. Doctor refuses to raise her cheap thyroid medicine and instead insists on a gpl. Even though she has other symptoms for low thyroid. insurance we had did pay for it. it makes no fucking sense. at times we can’t get stuff we need and at others we are given options we don’t want. A similar thing is there is this pretty cheap procedure called prp where they draw blood and centrifuge it down and dake the serum and inject it in a joint and it seems to relieve pain and does so for awhile. Like she could just get it once a year. They would not cover that but they did at one time. It kinda was based around what medicare was doing. They will pay for surgery that from our experinece may or may not make it better and may make it worse (we have more experience with surgery than anyone would want to have). That surgery is so expensive that if you were to stick the cost into a savings account it would easily make interest enough to do the prp. So even economics wise the insurance company should do the prp. Why don’t they. Because its like a game of chicken. people may get surgery but it does not always go well so many people will not get it. Also prp is done in the doctors office and does not require anything. They will pay for things from drug companies injected into the joint. We have just the worst system. Also you know why your insurance covers some things but not others? Some high muckity muck at your company want something. We had one that did unlimited chiro. Im like 100% the president or one of his family must get chiro adjustments every week or something. Either that or someone between the president and the hr level that decides on what insurance to use.