KuromiGirl04Mar 5

Can some please explain to me why it is that your health insurance can deny you medication, even if your doctor says you need it?

https://lemmy.world/post/43865952

Can some please explain to me why it is that your health insurance can deny you medication, even if your doctor says you need it? - Lemmy.World

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?

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The reason is that doctors and pharmaceutical companies are also for profit, meaning they make money selling you treatments. This puts them in a position to use your condition to exploit both you and the company. The insurance company is balancing the cost of your preferred treatment versus the cost of other treatment and the benefits. You can work with your doctor to build a documented record of attempting to lose weight- see a nutritionist, start seeing a therapist for your food addiction, start going to weight loss meetings, exercise therapy for the morbidly obese, etc. These will also be helpful by themselves, because those drugs are only temporary. Like weight loss surgery, people regain the weight when they don’t do the work to address the underlying issue.
Mar 5 at 1:39amWeb