No Stupid Questions

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.

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.

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.

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.

https://youtu.be/AZhCYisIQB8

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.

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.

Oh, I know the answer to this one. It's because we don't have single-payer healthcare, which Republicans don't want because they don't want bureaucratic death panels of disconnected doctors denying people access to medication.

They'd much prefer to have bureaucratic death panels entirely disconnected from any medical expertise denying people access to their medication and for spurious reasons.

The insurance companies want to make money.

There are no (enforced) laws prohibiting this behavior.

Very few insurance company decision makers are murdered in the street.

Change one or more of these, and you'll get better results.

Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too

It's not allowed, but then again, I'm not in the US.

Monied interests have crafted a legal system that benefits them, not you.

I hate that this is happening to you.

Darknet Markets are booming with semaglutides because of capitalism’s greed.

This is what pushed Luigi to allegedly merc one of them

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.

Money and the power of "fuck you".

:(

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.

The answer is evil greed.

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

Luigi...

My wife was prescribed one of those for her diabetes, and the insurance company STILL wouldn't cover a dime. She was able to find a coupon for a three month supply for $350.

Money.

You can get wegovy 28-day of the auto injectors through Amazon pharmacy for $200 a month without insurance. It still requires a prescription, but it sounds like you have that.

Obviously it would be better if your insurance would cover it, but $200 a month is better than the $600 a month some people are paying for ozempic/etc.

When signing up for insurance, you'll want to check their approved medications. My wife was prescribed mounjaro for her diabetes, but most of the insurance plans we looked at didn't have it listed as one of their approved medicines. It was one of the largest factors in deciding which insurance we needed to go with.

Because "business" and "dollar amounts" are more important than human life (some human life anyway).

Because there aren't enough Nintendo video game characters advocating for a change.

These drugs were originally diabetes drugs, that had the side effects of weight loss, but that wasn't their original use that they got FDA approval for.

So they are going back and getting them approved for different uses, and maybe one of those will get by the insurance company. I saw one being advertised for Sleep Apnia, which is common in obese people. It works because when you lose weight, your Apnia usually improves, so while they aren't selling it specifically for weight loss, that's the mechanism that improves the Apnia. Maybe your doctor can get it approved for that reason, or another one.

I was 350, and I've lost 100 pounds, without the drugs. I quit all sugary beverages, and only drink ice water or unsweet tea. I only eat when I'm hungry, and only until I'm not hungry. It allows me to eat whatever I want, but in strict moderation. It doesn't feel like a diet, though, because when I'm hungry I eat, but only until I'm not. I never eat more than a half sandwich. I will eat cookies, but only two, not half a package. When I have craving for chocolate, I'll eat 4 or 5 chocolate chips, one at a time, and let them melt on my tongue, so my chocolate craving gets fulfilled, without an entire candy bar.

And importantly, I developed a distraction. My Dad quit smoking years ago, by doing a Rubik's Cube whenever he got a craving. I took up the guitar. I keep an acoustic guitar next to my chair, and if I get a craving, instead of heading to the fridge, I pick up my guitar.

I didn't even increase my exercise, although I have a pretty physically active job. I've plateaued now, so I think it's time to increase my exercise for the last 50 I'd like to lose.

Keep at it, don't give up. It is far easier to lose weight at your age than after about 30, so do it now. Keep making adjustments in your diet and exercise, and eventually your metabolism will shift and start working with you.

They can't, they can only deny coverage for it. You can still get it paying for it yourself.