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?
Isn’t the insurance approving the medication/procedure only after being asked for proof the denial was legally obtained evidence that the denial was illegal, and reason enough for a lawsuit?
I have no idea, it might be worth checking with a couple attorneys who specialize in healthcare to see if you have a case worth pursuing as many will at least do a quick consult to see if you have a case without charging. The legal system is setup for wealthy people and organizations though so I wouldn’t expect much without something like practicing completely outside of their area or pretending to be from another state or something more than a lapsed certification or making judgements from a kinda similar but not really the same specialty.