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 not allowed, but then again, I’m not in the US.
Luigi…
Had the same experience. I ended up having my doctor write a prescription for wegovy pills and am just paying $200 out of pocket. I figure I’m at least breaking even by eating less. Only been a month so far.
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
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.
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.
they recently stopped covering glp-1 and similar for state subsidized healthcare, seems to coincide with it being lobbied against recently in congress.
Because everything in America is a privatized scam and the regulatory agencies are being completely dismantled
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.
Sadly there are some people i know who gain enough to look unhealthy if they dont eat a strict healthy vegan diet. And its easily to see in some cases. A friend of mine was very annoyed when she only got compliments after such rigorous effort. At that time her unhealtiest snack was dried strawberries.
On the other spectrum is me who cant gain any weight how matter what and how much i eat (cant even donate blood ;.;)
Bodies are VERY different and there are extremes where only meds can help and i think OP is one of them
she must be dehydrated if she eats “freeze dried strawberries”
She definetly hydrated helself properly with those 2L/Day bottles
True, and it could be easier for them to keep weight on, but CICO is a very basic science and will work if one keeps to it.
What a pointless post.
If my alternative would be 200$ per week, I’d take eating less as a solution.
And depressed people can save money by just smiling more!
My first reaction would be to say not the same thing, but then I remembered we’ve had studies recently that have confirmed that depression can genuinely be helped by leaving the house and touching grass.
But still not the same thing compared to depression, unless you have some eating related disorder or medical issue, the vast majority don’t and historically never have. The obseity epidemic is caused by caloric density creeping up in ultra processed foods, which already tells you everything you need to know, tricking people into thinking they eat a normal amount when they most definitely don’t.
The fact that this food is almost like a drug for some brains combined with the fact that some bodies struggle more than others with burning calories can make it more difficult at first for people but given difficult circumstances like having to pay 200$ per week to do something about it, there is always the free alternative. The difficulty in this case is more akin to quitting smoking or coffee. No one said it’s easy, but most could do it if they set their minds on it.
On a less brute force but not free path I would spend a fraction of that money on a dietician that can monitor my intake and make recommendations. At least that way there’s external support and motivation. I found they are like 100-200$ per month so an 8th to a quarter of the ozempic price.
While CICO is universally true, it doesn’t account for a few other factors. For instance, gut microbiome. Gut flora has a strong affect on cravings. Also mental and emotional health also affect self control and regulation. Food “science” has created craving
monstrositiessnacks that are as addictive as cigarettes. Personal health issues like PCOS and thyroid dysfunction will affect how many calories are consumed by the body and how those calories are used within the body.So yes, eat less and lose weight. Sure. Some people can lose weight eating junk. For others it creates a reward cascade in the brain that leads to overeating. Just eat less. For some that’s as practical as telling a lifelong smoker to give up the habit. And that’s why medical alternatives to self control exist, but aren’t successful without addressing the root cause of the obesity.
All those behavior cycles and feedback mechanisms are also literally what these GPL drugs suppress.
It’s like anxiety meds for someone who has diabilitating anxiety to just relax. Or more commonly telling the clinically depressed to just smile more.
Telling someone it’s a personal failing only fuels the feedback mechanism.
Medications exist because they stop the biological feedback loops.
Exactly!
I’m sure you think the whole world revolves around you, but without giving your country, how can anyone answer this?
I’ll assume you’re in the UK, and suggest you use the NHS.
I do not “think that the whole world revolves around me”
Then how would you expect anyone to answer about a country specific think like health insurance without saying what country you’re in? Are you Japanese?
No, I am not Japanese
Because only 'Muricas:
- Assume you know what country they’re in
- Have blatant healthcare issues
- Use random units that convert weirdly between themselves
- Get offended when you point any of this up
It is indeed curious that a place called “no stupid questions” is rampant with US defaultism.
They have their weight in lbs and talk about health insurance and for some reason you think the UK?
The NHS will prescribe both. Germany too because they have diabetes. If they don’t have diabetes the latter won’t, even though the medications have been approved by STILO for weight loss (that is, if you have a gesetzliche Versicherung, private insurance will prescribe them).
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
Why is this allowed?
It’s a private company operating under a contract that affords representatives ability to deny you payment for care on conditions that favor the company.
Why would it not be allowed?
The health insurance industry is an objectively evil but very profitable business model, that sustains itself directly on human misery.
This is allowed because our government is corrupt, paid off, and broadly dysfunctional, and/or controlled by ideological/religious extremists who hold bigotry of one kind or another as a fundamental principle.
This is allowed because exploiting your suffering makes a small number of people very wealthy.
And that small number of people runs everything by way of paying off nearly everyone involved in potentially regulating them, nearly every elected representative at the level of State government or higher.
You live in a failing, rogue, totalitarian, extremist state, run by pedophile rapist murderers who lie openly and brazenly every day.
You do not live in a well-run, representative democracy, that sees to the needs of its citizens.
You live it’s corpse.
Money and the power of “fuck you”.
:(
Because capitalism and culture of inequality
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.
Yes, i have in fact tried eating less
Do you keep your calories under a certain amount every day? Myfitnesspal used to be good for tracking that. Now I use cronometer!
Has it occurred to you that OP has heard advice like yours with varying levels of condescension literally all their life?
And they haven’t asked for weight loss advice in this thread. They asked for advice on accessing healthcare their doctor has deemed necessary.For some people that “eating fewer calories” part might be only eating a few hundred calories a day because of insulin resistance (hello?), certain medications they’re taking (like beta blockers) or plain old stupid genes.
The average resting human body burns like 1200-1800 calories a day. So no, not a few hundred lol. If OP ate around 2000 they’d probably start to lose weight.
Also: both of my parents have diabetes and they’re both relatively thin. It’s not that complicated.
LMAO @ “You missed one crucial thing: Have you tried eating less?”
What a ridiculous question.Stay strong and I hope you can get the medication you need.
I mean it is pretty crucial.
Assuming that someone who’s been trying to lose weight for 5 years never considered eating less is laughable and condescending.
It’s like telling someone with a severe substance addiction “You missed one crucial thing: Have you tried not doing drugs?”
True lol. It’s just that that’s usually the culprit. Eating less is really hard, and tons of people are addicted to food. I’m not trying to be the enemy here, despite what it seems. It’s the fact that OP didn’t say they tried eating less in their post, so that was what first came to mind.
And our bodies are just machines. We can’t create fat if were using the calories we consume. I don’t really get anyone who “tries” to lose weight for years. If you keep putting more food in your body than you need, your body converts it to fat. The idea of since “strange reason” that a body won’t lose weight is silly. There’s just no way for a body to keep weight on unless they are taking in more calories than they are using. So if OP can’t bear to eat less, they need to get really active. There really isn’t a mystery here. Its math. If you only add to the equation, the figure only increases. This is a willpower issue. … Or maybe we found the one obese American whose body defies caloric mathematics.
My weight varies around 50kg and there was a stretch of a few years where I tried bulking up to put on muscle. I found it very difficult and only got up to about 65kg where I plateaued (and it was damn difficult to get to that point—required an annoying amount of calorie-counting). I think my body is just naturally averse to putting on weight. It naturally follows that there are some people with the inverse problem, where their bodies naturally want to keep fat. I have friends who say they have this problem, and I have no reason to believe they’re lying; they know I wouldn’t judge if they just said they like eating and don’t feel like changing. There’s 8 billion people on Earth and plenty of genetic diversity among us. Of all the fat people in the world, you really think every single one of them is incapable of simply eating less? Or do you think I’m too stupid to decide to eat more food? Come on.
