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?
Because everything in America is a privatized scam and the regulatory agencies are being completely dismantled
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.
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
Hey OP, I will copy a point I made somewhere deeper in this thread that you might not see, because I do really believe that there is help to be had. I commend you on your desire to do something about this, since it will increase your quality of life in ways you never even imagined. Other people have also had great points I think and have touched on the tragedy that is the US medical system, I want to touch on the potential alternative solutions that are too often overlooked.
The obesity epidemic is caused by caloric density creeping up in ultra processed foods, tricking people into thinking they eat a normal amount when they most definitely don’t. The fact that these foods are 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 to loose weight, but you find yourself in the difficult circumstance of having to pay 200$ per week to do something about it, and there are two alternatives.
“Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle” - as an external observer with no context all I can read from this is that you replaced some unhealthy calories with some healthy calories. So the first proposal is calorie counting by yourself. You have to be anal about it, every little detail, any little snack has to be on your list and fully counted. If you do this properly and have a hard limit of 1500-2000 per day you will absolutely see results without having to do any excercise or eat any specific food. This is proven science at this point and anyone arguing about this is trying to sell you something or someone else sold them something. More colorful trends like intermittent fasting also achieve caloric deficit in a roundabout way, but in the end it doesn’t matter what approach you take, any way that works for you is fine, as long as you don’t go over the caloric limit. Losing weight is not exciting and doesn’t have some funny quirky solution, it’s just simple hard brute force.
Second, a little less brute force solution, but also not free, spend a fraction of that ozempic money on a registered dietician that can monitor your intake and make recommendations. At least that way there’s external support and motivation, as well as much needed help in case you have a history of eating disorder. I found they are like 100-200$ per month so an 8th to a quarter of the ozempic price. This is still going to be hard work, but with support and help from an expert it will be far easier to establish and maintain.
Both of these solutions will help build good habits and help you build an intuition for food caloric content at a glance. Ozempic, if it works, skips these important aspects, which might make you rebound after finishing the treatment, since you never actually learned how to manage your intake, just had reduced appetite for the duration of the treatment. Any aditional things you do like eating healthier and exercising will be a great bonus to your health, but you should honestly skip if they are overwhelming you and impeding you from achieving your goal. It’s normal to expect failure when the requirements are steep, so keep it a level you can manage. If calorie restriction is all you can do, then stick to that, but don’t compromise it ever because that is the absolute minimum. Everything else may come later.
I wish you good luck with your journey and hope you’ll enjoy the new life when you finally succeed.
Edit: bonus point I forgot to make earlier. Exercise may actually increase your appetite because that’s just how the body is wired. Which will make resticting calories even more difficult from a mental/willpower perspective. So it may be advisable to actually not exersice while you are trying to achieve your goals, because dealing with both changes of exercising and eating less at the same time can be too much and leads to failure of both. If you have to choose, always do the calorie restriction, like I said before, that is the minimum requirement, everything else is a bonus.
This does not refute your bonus point, because this is going to depend on who you are. Everyone is different, so ymmv, but as a systems thinker with VERY pronounced ADHD, counting (while it works on paper) has never actually worked for me past the first few weeks.
In my experience, though, when I am exercising, yes I may eat a bit more to replace what was spent, but I’m put in touch with my body a LOT more, and get clearer signals for what to eat. This often ends up becoming a kind of feedback loop, because I’ll start craving healthier foods that contain more micros, and are less calorically dense whole foods - mostly plants. I’m no longer eating just to get through, but responding to my body intuitively, which significantly reduces the cognitive load of “gotta eat healthy foods”. This is self-reinforcing too. As new microorganisms from specific foods colonize the gut, it pushes the brain to want more of those foods. (Sounds crazy, but it’s true.)
For example, maybe I’ll want a chopped up head of iceberg lettuce with shredded beets/carrots, SMALL portion of chicken/salmon/tofu and a piece of fruit instead of just that dense protein bar or bag of chips to keep me going. Good luck gaining weight on the first one - you would literally not have enough time in the day to prepare, eat and digest an amount that would add any weight.
Exercise doesn’t have to be crazy strenuous either. Just moving at all helps, and low impact movement can help tremendously with the aches and pains that can come with extra weight. OP is very young, and might not be feeling it yet, but she will.
Walking, swimming, cycling, and yoga are all fantastic places to start out, and those activities do have varying levels of accessibility but they’re still all very achievable for the vast majority of people.
CICO is fundamental science at the level of basic physics, but there’s also human psychology and the brain-gut connection to contend with. Layering other things on top of CICO, to that end, could result in compounding effects which accelerate and complement a foundation of rote calorie counting. A whole-system approach that integrates movement, nutrition and food prep skills together with intuitive eating is very much worth trying and is more likely to last long term IMO. With enough practice, this became a new normal. I feel great, keep a healthy stable weight and don’t even think about calories anymore tbh.
Because your congressperson is bought and paid for and there aren’t enough people assassinating health insurance CEOs in the street to inspire them to change their ways.
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.
It doesn’t cost $350/mo/person to produce these drugs. Manufacturers brazenly price gouge knowing no goverment body would retaliate.
This is a problem that can be solved by legislation and cutting out the middle-man(insurance companies) by expanding medicare for all.
Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
Good. Fuck em all and replace the whole thing with a system that works.
Oh no! Not the health
careinsurance industry.
It’s not allowed, but then again, I’m not in the US.
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.
Because capitalism and culture of inequality
Look into compound pharmacies, you can get it for under $50 a month that way and not have to deal with insurance at all.
Sorry you are getting such negaticve responses here, people dont realize ozempic actually helps you to eat less and make the lifestyle changes people insist anyone can do without help. Feel free to dm me if you need additional help.
Money.
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.
The insurance company is going to have a doctor who said you don’t need it. They will try to hide who that doctor is, specifically what their NPI is, which can be used to personally identify the doctor who made the medical judgement against your doctor’s without having to provide further explanation than they’ve already given. Depending where you are they may have to provide more information when directly asked for specific evidences, or will suddenly change their rejection on the claim with a letter from an attorney asking for specific details in writing. They know hiring an attorney is expensive and bank on people not advocating for their rights & people with severe medical issues not being able to afford to.
And lastly a video of a surgeon being denied the NPI of the insurance’s doctors who are likely breaking the law hiding behind the idea that insurance doctors are so hated they need to hide their identity even from other doctors to prevent reprisal. She was blacklisted from United claims for this video and others like it.
The insurance company is going to have a doctor who said you don’t need it.
To add on to this, my psychologist told me that he’s had antipsychotic meds denied by a urologist before, because the insurance companies often don’t actually care what field the doctor is in. All they care about is getting to say “a doctor” reviewed it.
I have a relative who is a doctor. Had a claim denied once from someone that was not a doctor. Next: denied by someone not actively practicing in the field. Then denied by a doctor with no experience in that specialty. Only after all of that was it approved. They’ve also been picky about order of operations, such as not covering an MRI because there wasn’t also an order for a CT.
And you can leverage that in your appeal letter.
Especially when you have a pissy provider who doesn’t like being told “no.”
then they have teams to review the first insurance agent approved your medications, and sometimes a team to review that teams decision of said medication. they will do this til you give up.
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.
This is the lore. I haven’t heard from anybody trying it, I hope OP will make the attempt and report back.
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)
If that was the case we’d have one of the most efficient medical systems in the world instead of one of the least
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.
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 drugs.
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.
